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Gastrointestinal > UW 2 > Flashcards

UW 2 Flashcards

1
Q

diffuse esoph spasm - symptoms

A
  1. intermittent chest pain

2. dysphagia for solids + liquids

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2
Q

diffuse esoph spasm - diagnosis

A
  • manometry: intermittent peristalsis, multiple simultaneous contractions
  • esophagram: corkscrew pattern
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3
Q

diffuse esoph spasm - treatment

A

CCB

alternates: nitrates or tricyclics

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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

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5
Q

hepatic adenoma - complications

A
  1. hemorrhage

2. MALIGNANT TRANSFORMATION

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6
Q

focal nodular hyperplasia

A

anomalous arteries

  • arterial flow + central scar on imaging
  • resemble to adenoma, but not associated to OCPs
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7
Q

Ulcerative colitis - complications

A
  1. toxic megalcolon
  2. 1ry sclerosing cholangitis
  3. Colorectal Ca
  4. Erythema nodousm, pyoderma gangrenosum
  5. spondyloarthritis
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8
Q

UC - biopsy

A
  1. mucosal + submucosal infl

2, crypt abscessess

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9
Q

UC - Endoscopic findings - endoscopic findings

A
  1. erythema, griable mucosa
  2. pseudopolyps
  3. involvement of rectosigmoid
  4. no skip lesions
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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
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11
Q

acetaminophen intoxitation - level of AST/ALT

A

more than 1000

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12
Q

suspect toxic megacolon - initial test

A

abdominal X-ray

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13
Q

acute diverticulitis - diagnosis

A

abd CT (oral + IV contrast)

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14
Q

acute diverticulitis - management

A

bowel rest

- antibiotics: cipro or metronidazole)

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15
Q

colonoscopy in acute diverticulitis

A

never –> it can cause perforation

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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

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17
Q

lactose intolerance - labs

A
  1. (+) hydrogen breath test
  2. (+) stool test for reducing substance
  3. low stool ph
  4. increased stool osmotic gap
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18
Q

DDX of very high AST and ALT

A
  1. toxin induced (eg. acetaminophen)
  2. ischemic
  3. viral hepatitis
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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

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20
Q

nonbleeding varices - prevention

A
  • nonselective beta blockers (eg. propranolol, nadolol)

- if contraindications of beta blockers –> endoscopic variceal ligation

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21
Q

octreotide for active varices bleeding

A

used in active bleeding

no prole in primary prophulaxis

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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
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23
Q

clinical findings suggest cirrhosis - next step

A

ensoscopy to screen for varices

- biopsy is not required

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24
Q

Lynch syndrome - type of cancer

A
  1. CRC
  2. Endometrial
  3. Ovarian
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25
Q

Crohn vs UC regarding intestinal complications

A

Crohn: fistulas, stricutres, abscesses
UC: toxic megacolon

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26
Q

Cholesterol embolism can occur after vasculr procedure - complications

A
  1. skin (eg. livedo reticularis, blue toe)
  2. GI (eg. mesenteric ischemia, acute pancreatitis)
  3. Acute kidney injury
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27
Q

acute pancreatitis by uncorrectable causes can be ….. (treatment)

A

conservatively management with analgesics and IV fluids

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28
Q

esophageal cancer - diagnosis

A
  1. endoscopy with biopsy

2. CT (PET/CT) for staging

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29
Q

IBD - age of onset

A

Bimodal: 15-40, 50-80

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30
Q

chronic pancreatitis - treatment

A
  1. pain management
  2. alcohol + smoking cessation
  3. frequent, small meals
  4. pancreatic enzyme supplements
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31
Q

Chronic pancreatitis - manurves to relief pain

A
  1. sitting upright

2. leaning forward

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32
Q

causes of renal insufficiency in acute liver failure

A

common esp when acetaminophen induced, due to drug’s direct renal tubular toxicity

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33
Q

drugs that cause esophagitis

A
  1. tetracyclines
  2. Aspirin + NSAID
  3. Alendronate
  4. Iron
  5. Potasium chloride
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34
Q

acute cholangitis - clinical presentation

A

Charcot triad: Fever, jaundice, pain

Reynolds pentad: PLUS hypotension and alter mental status

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35
Q

Acute cholangitis - treatment

A
  1. antibiotic to cover enteric bacteria

2. biliary drainage by ERCP within 24-48 h

36
Q

secretory diarrhea

A

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
Q

ERCP for diagnosis of Pancreatic cancer

A

vert sensitive + specific

- reserved for those who have already undergone nondiagnostic U/S and CT

38
Q

laxative abuse - diagnosis

A
  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
Q

Clinical features of irritable bowel syndrome - Rome diagnostic criteria

A

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
Q

sings and symptoms suggenstin other than IBS

A
  1. bleeding
  2. nocturnal or worsening pain
  3. woight loss
  4. abnormal labs (anemia, electrolytes etc)
41
Q

colovesical fistula - etiology (MCC)

A
  1. diverticular disease (MC)
  2. Crohn disease
  3. Maligancy (clon, bladder, pelvic organ)
42
Q

colovesicular fistula - diagnosis

A
  1. abdominal CT with oral or rectal (NOT IV) contrast

2. colonoscopy to exclude colonic malignancy

43
Q

colovesicular fistula - treatment

A

usually surgery

44
Q

emphysematous pyelonephritis

A

pyelonephritis due to gas-producing infection, typically in patients with DM

45
Q

recovery vs resolved HBV

A
  • resolved: (+) antiHBs + HBc but (-) HBsAG

- recovery: anti-HBs, HBc (IgG and HbE

46
Q

typical clinical presentation + enzymes - how to confirm pancreatitis

A

no need to confirm

if unclear or fail to improve –> CT

47
Q

colon cancer screening in patients at increased risk - indications

A
  1. Family history of adenomatous polyps or CRC
  2. FAP
  3. IBD (UC or Crohn with colonic involvement)
  4. Lynch syndrome
48
Q

familty history of adematoys polyps or CRC - screening

A
  • 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
Q

IBD - screening for CRC

A

colonoscopy 8-10 years postdiagnosis (12-15 if disease only in Left colon)
- every 1-3 years

50
Q

FAP - screening

A

start colonoscopy at 10-12 years old
repeat every year
- also regular screening for upper GI

51
Q

Lynch syndrome - screening

A
  • start at 20-25

- every 1-2 years

52
Q

IBD - dysplasia in colonoscopy - management

A

prophylactic colectomy

53
Q

diverticular hemorrhage - management

A

usually resolves sponanteously

ocassionally requires endoscopic or surgical intervention

54
Q

likely pancreatic cancer - U/S vs CT

A

if jaundice –> U/S

if not jaundice –> CT

55
Q

GERD management

A

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
Q

GERD - alarm symptoms

A
  1. melena
  2. persistent vomiting
  3. hematemesis
  4. weight loss
  5. anemia
  6. dysphagia/odynophagia
57
Q

DDX of esophagitis

A
  1. pill esophagitis
  2. autoimmune skin disease
  3. Zollinger ellison
  4. eosinophilic esophagitis
  5. Barrett
58
Q

elderly with new iron depleted anemi and single negative fecal occult blood tests - next step

A

endoscopy and colonoscopy

59
Q

FAP syndrome - aspirin

A

aspirin reduces the risk for CRC in avarage, non in FAP

60
Q

management of FAP

A

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
Q

indications for proctocolectomy in fap

A
  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
Q

worsening after n-acetylcysteine for acetaminophen overedose –> ….

A

transplantation

63
Q

a potential complication of acute liver failure

A

cerebral edema –> coma + brain stem herniation –> death

64
Q

chronium def - manifestation

A

impaired glucose control in DM

65
Q

copper deficiency - manifestation

A
  1. brittle haie
  2. skin depigmentation
  3. neurologic dysfunction
  4. sideroblastic anemia
  5. osteoporosis
66
Q

selenium deficiency - manifestation

A
  1. thyroid dysfunction
  2. cardiomyopathy
  3. immune dysfunction
67
Q

zinc deficiency - manifestation

A
  1. alopecia
  2. pustular skin rash (perioral region + extr_
  3. hypogonadism
  4. impaired wound healing
  5. impaired taste
  6. immune dysfunction
68
Q

angiodysplasia?

A

dilated submucosal veins and AV malformations –> recurrent painless GI bleeding
- diagnosis with colonoscopy (frequently missed)

69
Q

angiodysplasia - treatment

A

if asymptomatic no

if anemia or bleeding –> cautery

70
Q

angiodysplasia is associated with

A
  1. advanced renal disease
  2. VWF
  3. aortic stenosis
71
Q

acute liver failure - diagnostic requirements

A
  1. severe acute liver injury (enzymes more than 1000)
  2. signs of hepatic encphalopathy
  3. Syntehtic liver dysfunction (INR more than 1.5)
72
Q

features associated with severe pancreatitis

A
  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
Q

mechanism of hypotension is severe pancreatitis

A

increased vascular permeability

74
Q

marked elevation of liver enzymes - think of

A

toxic (acetaminophen), ischemic, viral

under 300 in alcohol

75
Q

ferritin levels in alcohol liver disease

A

elevated

76
Q

another cause of acute pancreatitis

A

cholesterol embolism

77
Q

hepatic encephalopathy on diuretics - next step

A

volume resuscitation and correct poassium

78
Q

esophageal adenoca - how many years of GERD

A

20

79
Q

autoimmune hepatitis - antibodies

A
  1. ANA - sensitive

2. Anti- SMC senseitive and sepcific

80
Q

GI bleeding - indications for Packed red blood cell transfusion

A

under 7

- - under 9 if ACS

81
Q

platelet transfusion indications

A

under 10

under 50 with active bleeding

82
Q

Whole blood transfusion

A

sever haemorrhage (eg. major trauma) requiring massive blood transfusion to assist in volume expansion

83
Q

hepatic adenoma - image

A

U/S well demarcated, hyperechoic lesions
CT with contrast: early periphearl enchancement
- NO BIOPSY

84
Q

types of diarrhea

A
  1. fatty
  2. watary –> secretory, watery, osmotic
  3. inflammatory
85
Q

how to distinguish secretory from osmotic diarrhea

A

stool osmotic gap = plasma - 2 x (stool Na2+ + stool K+)

  • increased in osmotic
  • decreased in secretory

Gastrointestinal (4 decks)

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