UW 2 Flashcards
1
Q
diffuse esoph spasm - symptoms
A
- intermittent chest pain
2. dysphagia for solids + liquids
2
Q
diffuse esoph spasm - diagnosis
A
- manometry: intermittent peristalsis, multiple simultaneous contractions
- esophagram: corkscrew pattern
3
Q
diffuse esoph spasm - treatment
A
CCB
alternates: nitrates or tricyclics
4
Q
upper GI bleeding with depressed level of consciousness and ongoing hematemesis –> next..
A
intubate to protect airway and then endoscopic treatment with ligation or sclerotherapy
5
Q
hepatic adenoma - complications
A
- hemorrhage
2. MALIGNANT TRANSFORMATION
6
Q
focal nodular hyperplasia
A
anomalous arteries
- arterial flow + central scar on imaging
- resemble to adenoma, but not associated to OCPs
7
Q
Ulcerative colitis - complications
A
- toxic megalcolon
- 1ry sclerosing cholangitis
- Colorectal Ca
- Erythema nodousm, pyoderma gangrenosum
- spondyloarthritis
8
Q
UC - biopsy
A
- mucosal + submucosal infl
2, crypt abscessess
9
Q
UC - Endoscopic findings - endoscopic findings
A
- erythema, griable mucosa
- pseudopolyps
- involvement of rectosigmoid
- no skip lesions
10
Q
alcoholic hepatitis - LABS
A
AST + ALT usually less than 300 AST: ALT: MORE THAN 2 - Leukocytotis (esp neutrophils) - low albumin in malnourishedt - elevated ferritin
11
Q
acetaminophen intoxitation - level of AST/ALT
A
more than 1000
12
Q
suspect toxic megacolon - initial test
A
abdominal X-ray
13
Q
acute diverticulitis - diagnosis
A
abd CT (oral + IV contrast)
14
Q
acute diverticulitis - management
A
bowel rest
- antibiotics: cipro or metronidazole)
15
Q
colonoscopy in acute diverticulitis
A
never –> it can cause perforation
16
Q
liver enzymes in hypotension
A
iscehemic hepatic injury –> massive increase in the AST and ALT with milder associated increases in the total bilirubin and ALP
17
Q
lactose intolerance - labs
A
- (+) hydrogen breath test
- (+) stool test for reducing substance
- low stool ph
- increased stool osmotic gap
18
Q
DDX of very high AST and ALT
A
- toxin induced (eg. acetaminophen)
- ischemic
- viral hepatitis
19
Q
nonalcoholic fatty liver disease is frequently associated with
A
insulin resistance –> increased peripheral lipolysis, TG synthesis, and hepatic uptake of fatty acids
- hepatic free fatty acids increases oxidative stress and production of proinflammatory cytokines
20
Q
nonbleeding varices - prevention
A
- nonselective beta blockers (eg. propranolol, nadolol)
- if contraindications of beta blockers –> endoscopic variceal ligation
21
Q
octreotide for active varices bleeding
A
used in active bleeding
no prole in primary prophulaxis
22
Q
Management of Cirrhosis
A
periodic surveillance of LFT
- Compensated: U/S for HCC ever 6 months and EGD
- decompensated –> assess complications:
a. variceal hemor: start beta blocker and EGD every year
b. ascitie: low sodium, diuretics, paracentesis, no alcohol
c. encephalopathy: lactulose
23
Q
clinical findings suggest cirrhosis - next step
A
ensoscopy to screen for varices
- biopsy is not required
24
Q
Lynch syndrome - type of cancer
A
- CRC
- Endometrial
- Ovarian
25
Crohn vs UC regarding intestinal complications
Crohn: fistulas, stricutres, abscesses
UC: toxic megacolon
26
Cholesterol embolism can occur after vasculr procedure - complications
1. skin (eg. livedo reticularis, blue toe)
2. GI (eg. mesenteric ischemia, acute pancreatitis)
3. Acute kidney injury
27
acute pancreatitis by uncorrectable causes can be ..... (treatment)
conservatively management with analgesics and IV fluids
28
esophageal cancer - diagnosis
1. endoscopy with biopsy
| 2. CT (PET/CT) for staging
29
IBD - age of onset
Bimodal: 15-40, 50-80
30
chronic pancreatitis - treatment
1. pain management
2. alcohol + smoking cessation
3. frequent, small meals
4. pancreatic enzyme supplements
31
Chronic pancreatitis - manurves to relief pain
1. sitting upright
| 2. leaning forward
32
causes of renal insufficiency in acute liver failure
common esp when acetaminophen induced, due to drug's direct renal tubular toxicity
33
drugs that cause esophagitis
1. tetracyclines
2. Aspirin + NSAID
3. Alendronate
4. Iron
5. Potasium chloride
34
acute cholangitis - clinical presentation
Charcot triad: Fever, jaundice, pain
| Reynolds pentad: PLUS hypotension and alter mental status
35
Acute cholangitis - treatment
1. antibiotic to cover enteric bacteria
| 2. biliary drainage by ERCP within 24-48 h
36
secretory diarrhea
larger daily stool vomulumes and diarrhea that occurs even during fasting, reduced stool omotic gap
- due to increased secretion of ions
- causes: V. cholera, rotavirus, CF, early ielocolitis, POSTSURGICAL CHANGES
37
ERCP for diagnosis of Pancreatic cancer
vert sensitive + specific
| - reserved for those who have already undergone nondiagnostic U/S and CT
38
laxative abuse - diagnosis
1. (+) laxative screen
2. colonoscopy with characteristic melanosis coli (dark brown discoloration with pale patches of lymph follicles)
3. biopsy: pigment in the macrophages of the lamina propria
39
Clinical features of irritable bowel syndrome - Rome diagnostic criteria
Reccurent abd pain / discomfort 3 or more days per month for the past 3 months PLUS at least 2 of:
- change in form of stool
- change in frequency of stool
- symptom improvement with bowel movement
40
sings and symptoms suggenstin other than IBS
1. bleeding
2. nocturnal or worsening pain
3. woight loss
4. abnormal labs (anemia, electrolytes etc)
41
colovesical fistula - etiology (MCC)
1. diverticular disease (MC)
2. Crohn disease
3. Maligancy (clon, bladder, pelvic organ)
42
colovesicular fistula - diagnosis
1. abdominal CT with oral or rectal (NOT IV) contrast
| 2. colonoscopy to exclude colonic malignancy
43
colovesicular fistula - treatment
usually surgery
44
emphysematous pyelonephritis
pyelonephritis due to gas-producing infection, typically in patients with DM
45
recovery vs resolved HBV
- resolved: (+) antiHBs + HBc but (-) HBsAG
| - recovery: anti-HBs, HBc (IgG and HbE
46
typical clinical presentation + enzymes - how to confirm pancreatitis
no need to confirm
| if unclear or fail to improve --> CT
47
colon cancer screening in patients at increased risk - indications
1. Family history of adenomatous polyps or CRC
2. FAP
3. IBD (UC or Crohn with colonic involvement)
4. Lynch syndrome
48
familty history of adematoys polyps or CRC - screening
- 1st degree relative under 60 or 2 first degree relatives any age
- start colonoscopy at 40 or 10 years before the age of diagnosis of relative
- every 5 years
49
IBD - screening for CRC
colonoscopy 8-10 years postdiagnosis (12-15 if disease only in Left colon)
- every 1-3 years
50
FAP - screening
start colonoscopy at 10-12 years old
repeat every year
- also regular screening for upper GI
51
Lynch syndrome - screening
- start at 20-25
| - every 1-2 years
52
IBD - dysplasia in colonoscopy - management
prophylactic colectomy
53
diverticular hemorrhage - management
usually resolves sponanteously
| ocassionally requires endoscopic or surgical intervention
54
likely pancreatic cancer - U/S vs CT
if jaundice --> U/S
| if not jaundice --> CT
55
GERD management
Men older than 50 or symptoms more than 5 years, or cancer risk factors or alarm symptoms?
A. NO -- once daily PPI for 2 months --> if refractory switch to different PPI or increase PPI to 2 daily --> if controlled then continue, if not the endoscopy or ph minoring
B. YES --> endoscopy:
- esophagitis: treat it
- no esophagitis --> consider further testing for: achalasia, gastroparesis, nonacid reflux, etc --> manometry, impedance testngm gastric scintigraphy
56
GERD - alarm symptoms
1. melena
2. persistent vomiting
3. hematemesis
4. weight loss
5. anemia
6. dysphagia/odynophagia
57
DDX of esophagitis
1. pill esophagitis
2. autoimmune skin disease
3. Zollinger ellison
4. eosinophilic esophagitis
5. Barrett
58
elderly with new iron depleted anemi and single negative fecal occult blood tests - next step
endoscopy and colonoscopy
59
FAP syndrome - aspirin
aspirin reduces the risk for CRC in avarage, non in FAP
60
management of FAP
annual screening sigmoidoscopies for children starting at 10-12 followed by annual colonoscopies once corlorectal adenomas are detected or if the patient is age more than 50. Patients with attenuated version of FAP can have delayed start of screening (25) and longer intervals (1-2 years)
- Proctocolectomy if present with CRC r adenomas with high grade dysplasia)
61
indications for proctocolectomy in fap
1. present with CRC or adenomas with high dysplasia
2. symptoms from colonic neoplasia (hemorrhage)
3. signif increase in polyp number during interval
- if not all above --> surgey at 20
62
worsening after n-acetylcysteine for acetaminophen overedose --> ....
transplantation
63
a potential complication of acute liver failure
cerebral edema --> coma + brain stem herniation --> death
64
chronium def - manifestation
impaired glucose control in DM
65
copper deficiency - manifestation
1. brittle haie
2. skin depigmentation
3. neurologic dysfunction
4. sideroblastic anemia
5. osteoporosis
66
selenium deficiency - manifestation
1. thyroid dysfunction
2. cardiomyopathy
3. immune dysfunction
67
zinc deficiency - manifestation
1. alopecia
2. pustular skin rash (perioral region + extr_
3. hypogonadism
4. impaired wound healing
5. impaired taste
6. immune dysfunction
68
angiodysplasia?
dilated submucosal veins and AV malformations --> recurrent painless GI bleeding
- diagnosis with colonoscopy (frequently missed)
69
angiodysplasia - treatment
if asymptomatic no
| if anemia or bleeding --> cautery
70
angiodysplasia is associated with
1. advanced renal disease
2. VWF
3. aortic stenosis
71
acute liver failure - diagnostic requirements
1. severe acute liver injury (enzymes more than 1000)
2. signs of hepatic encphalopathy
3. Syntehtic liver dysfunction (INR more than 1.5)
72
features associated with severe pancreatitis
1. older than 75
2. obesity
3. alcoholism
4. CRP greater than 150 at 48h
5. Rising BUN + creatining in 48h
6. Chest x-ray with pulm infiltrates or pleural effusion
7. CT/MRI with necrosis + extrapancreatic infl
73
mechanism of hypotension is severe pancreatitis
increased vascular permeability
74
marked elevation of liver enzymes - think of
toxic (acetaminophen), ischemic, viral
| under 300 in alcohol
75
ferritin levels in alcohol liver disease
elevated
76
another cause of acute pancreatitis
cholesterol embolism
77
hepatic encephalopathy on diuretics - next step
volume resuscitation and correct poassium
78
esophageal adenoca - how many years of GERD
20
79
autoimmune hepatitis - antibodies
1. ANA - sensitive
| 2. Anti- SMC senseitive and sepcific
80
GI bleeding - indications for Packed red blood cell transfusion
under 7
| - - under 9 if ACS
81
platelet transfusion indications
under 10
| under 50 with active bleeding
82
Whole blood transfusion
sever haemorrhage (eg. major trauma) requiring massive blood transfusion to assist in volume expansion
83
hepatic adenoma - image
U/S well demarcated, hyperechoic lesions
CT with contrast: early periphearl enchancement
- NO BIOPSY
84
types of diarrhea
1. fatty
2. watary --> secretory, watery, osmotic
3. inflammatory
85
how to distinguish secretory from osmotic diarrhea
stool osmotic gap = plasma - 2 x (stool Na2+ + stool K+)
- increased in osmotic
- decreased in secretory
