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3. GI Flashcards

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1
Q

GI hormone pathway

A

G cell -> gastrin -> parietal cell -> hydrochloric acid

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2
Q

Cholelithiasis vs Acute Cholecyctitis vs choledocholithiasis vs Acute Cholangitis

Cause/Sx/Dx/Tx

Risk factor for gallstone?

A

Cholelithiasis (billary colic)

  • Cause: gallstone in gallbladder but not inflammed
  • Sx: after fatty food, then pain
  • Dx: US
  • Tx: Observe or elective

Acute cholecyctitis

  • Cause: gall bladder duct blocked by stone which cause inflammed
  • Sx: RUQ pain, Fever,
    • Murphy sign (deep breath push pain)
    • Psoas sign (shoulder pain)
  • Dx: US first, HIDA (best)
  • Tx: Fluid, Ceftx + Metro (CM)

Choledocholithiasis

  • Cause: Stone in common bile duct but No inflammed
  • Sx: RUQ pain, Jaundice
  • Dx: US (first), ERCP (best)
  • Tx: ERCP

Acute Cholangitis

  • Cause: infection due to obstruction MC E coli
  • Sx: Fever, RUQ pain, Jaundice
  • Dx: US (first), ERCP (best)
  • Tx: ERCP + ABX (Ceftx + Metro)

Female, forty age, fertile (pregnancy), fat

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3
Q

Charcot vs Raynoid pentad

Explain

which group of peplpe has high risk of gallbladder stone?

A
  • Charcot - fever, RUQ pain, Jaundaice
  • Raynoid pentad - Fever RUQ pain, Jaundice

Native american

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4
Q

Primary Sclerosing Cholangitis vs Primary billary cirrhosis

Cause/Sx/Dx/Tx

A

PSC

  • Cause: Sclerosing of bile duct to strictures (autoimmune)
  • Sx: Pruritus, jaundice
  • Hx: UC
  • Dx: ERCP (best)
    • Lab: ALP GGT evelvated, P ANCA +
  • Tx: Liver transplant

PBC

  • Cause: T cell attack bile duct and destruction
  • Sx: Pruritus, Jaundice
  • Dx: AMA (antimitochondrial antibody), Bx (definitive)
    • ALP, GGT elevated
  • Tx: Ursodeoxycholic acid
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5
Q

Pilonidal

Cause/Sx/PE/Tx

A
  • Cause: abscess sacroccygeal cleft
  • Sx: Tender
  • PE: Tender, Fluctuant
  • Tx: I & D, Surgical excision (definitive)
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6
Q

Anal fissure

Sx/PE/Tx

A
  • Cause: hard stool, constipation
  • Sx: Rectal pain, may bleed
  • PE: Posterior of midline tear, Lateral tear - Crohn, malignacy
  • Tx: Supportive (sitz bath, fiber, topical analgesic, Nitroglycerin)
    • Lateral internal sphincterotomy for chronic
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7
Q

Fecal impaction

Cause/medication cause/Sx/Tx

A
  • Cause: infrequent bowel movement
  • Medication: verapamil
  • Sx: abd distension and pain
  • Tx: Stool softener (psyllium, PEG)
    • if failed conservative, Fecal disimpact by hand and Enema washout
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8
Q

Diverticulosis vs Diverticulitis

Cause/Sx/Dx/Tx

A

Diverticulosis

  • Cause: Outpouching of colon But not inflammed (low fiber)
  • Sx: painless Bleeding
  • Dx: CT
  • Tx: high fiber diet, supportive

Diverticulitis

  • Cause: Outpouching of colon scarred and inflammed
  • Sx: Painful NO bleeding, fever
  • Dx: CT, NO colonoscopy
  • Tx: clear liquid diet (low fiber) + Cipro + Metro
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9
Q

Hemorrhoids

Internal vs External

Sx/Tx/Special comment

A

Internal

  • Sx: Painless bright bleed above dentate line
  • Tx: Sitz Bath, high fiber diet, if large, Rubber band ligation

External

  • Sx: Painful perianal pain with defecation
  • Tx: Excision, topical hydrocortisone helpful

Special comment: MC cause rectal bleed

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10
Q

UC (ulcerative colitis) vs Crohn

Site/Depth/Sx/Dx/Tx/Special risk

A

Ulcerative colitis

  • Site: Always involve rectum
  • Depth: Not muscle involve
  • Sx: bloody, Tenesmus
  • Dx: Flex sigmoidoscopy, CI: colonoscopy acute colitis
    • Uniform inflammation
  • Tx: Sulfasalazine, surgery is curative
  • Special risk: colon cancer, toxic megacolon

Crohn

  • Site: Keep legion can be any GI tract
  • Depth: Transural
  • Sx: No blood, pain RLQ
  • Dx: Colonoscopy
    • Skip lesion, cobblestone appearance
  • Tx: Mesalamine, surgery not curative
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11
Q

IBS

Patient/Sx/Dx/Tx

A
  • Patient: Women
  • Sx: Constipation and diarrhea alternating
  • Dx: Rome criteria 1d/week for 3month, CBC fo anemia
    • Sx related with defecation
    • Frequency of stool
    • Form of stool
  • Tx: low fat diet, supportive care
    • Constipation - bulk laxatative (psyllium)
    • Diarrhea - loperamide
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12
Q

Ischemic colitis

Cause/Hx/Sx/Dx/Tx

A
  • Cause: Blood flow interfere (superior mesenteric artery involve)
  • Hx: Atherosclerosis
  • Sx: Sudden abd pain
  • Dx: CT
  • Tx: supportive care
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13
Q

Mesenteric ischemia

Cause/Hx/Sx/Dx/Tx

A
  • Cause: emboli ostruction mesenteric artery
  • Hx: a fib, MI, CAD
  • Sx: out of proportion pain
  • Dx: Angiogram
  • Tx: surgical revascularization
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14
Q

Toxic megacolon

Hx/Sx/Dx/Tx

A
  • Hx: UC, Crohn
  • Sx: abd pain
  • Dx: X-ray abd dilated more than 6cm
  • Tx: bowel decompress, IV fluid, bowel rest, NG tube
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15
Q

Large bowel obstruction

MC site/Cause/Sx/PE/Dx/Tx

A
  • MC site: Sigmoid
  • Cause: MC colorectal cancer
  • Sx: Distended bowel
  • PE: hyperresonance
  • Dx: X-ray (haustra present)
  • Tx: NG tube
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16
Q

Polyps in intestine

Cancerous Site/Main concern/MC population w/ painless bleeding/follow up

A
  • Cancerous site: Proximal
  • Main concer: Malignant transform
  • MC population w/ painless bleeding: pediatric
  • Follow up: Once identified colonoscopy Q3-5y
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17
Q

Familial adenomatous polyposis (FAP)

Cause/Patient/Screening

A
  • Cause: multiple polyps (hundreds)
  • Patient: polyps development average 15yo and cancer at 40 yo
  • Screening
    • if first degree relative - genetic screening at 10 yo
    • Sigmoidoscopy start at 12 yo
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18
Q

Esophagitis

Cause/Dx finding/Tx

A

Infection

  • 3 Type cause
    • Candida - white plaque
    • CMV - deep
    • HSV - Shallow
  • Dx: Endoscopy
  • Tx
    • Candida - fluconazole
    • CMV - ganciclovir
    • HSV - acyclovir

Eosinophillic

  • Cause: allergic MC in children
  • Dx: Endoscopy - multiple corrugated rings
  • Tx: remove

pill-induced - bisphosphonates

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19
Q

GERD

Cause/Increase GERD/Sx/Dx/Tx

A
  • Cause: weak muscle in LES, acid leaks out
  • Increase GERD: Caffeine
  • Sx: Heartburn laydown painful after food
  • Dx: Trial of H2 and PPI (initial) Endoscopy (dysphagia, odynophagia, weight loss, persistent vomiting, palpable mass or adenopathy or positive FOBT), 24hr Ph monitoring (Gold)
  • Tx
    • 1st: Life modification
    • 2nd: OTC antacid, H2 blocker
    • 3rd: PPI
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20
Q

Barrett’s esophagus

Hx/Dx/Tx/Special risk

A
  • Hx: Chronic GERD
  • Dx: endoscopy, Bx (squamous to columnar)
  • Tx: PPI
  • Special risk: adenocarcinoma
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21
Q

Achalasia

Cause/Sx/Dx/Tx

A
  • Cause: loss of auerbach’s plexus
  • Sx: dysphagia to both solids & liquids
  • Dx: Manometry (gold), Barium (bird beak)
  • Tx: botulinum injection
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22
Q

Mallory-weiss syndrome

Cause/Hx/Sx/Dx/Tx

A
  • Cause: tear
  • Hx: Forceful vomitting
  • Sx: bleeding
  • Dx: Endoscopy
  • Tx: Supportive care
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23
Q

Esophageal spasm

Cause/Sx/Dx/Tx

A
  • Cause: strong contraction of esophagus
  • Sx: Dysphagia of solid and liquid
  • Dx: Manometry (Corkscrew look)
  • Tx: CCB, botox
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24
Q

Esophageal Stricture

Type 3/Sx/Dx/Tx

A
  • Type
    • Web - mid upper
    • Ring - lower
    • Plummer - dysphagia + web + Iron deficiency
  • Sx: Can’t swallow solid
  • Dx: Barium
  • Tx: Dilation + PPI
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25
Esophageal varices Cause/Hx/Dx/Tx/Prevention
* Cause: Portal HTN * Hx: Alcholism, liver dz * Dx: Endoscopy * Tx: Octreotide * Prevention: CCB, BB
26
Boerhaave syndrome Cause/Sx/Hx/Dx/Tx
* Cause: Iatrogenic perforation of esophagus * Sx: breathing or swallowing retrosternal chest pain * Hx: Endoscopy was done * Dx: Barium * Tx: IV fluid + NPO, if large surgical repair
27
Celiac disease Cause/Sx/Dx/Tx/Related Dz
* Cause: gluten cause loss of villi * Sx: diarrhea, dermatitis herpetiforms, **weight loss** * Dx: Iga antidomysial (EMA), bx (definitive) * Tx: Gluten free diet * Related Dz: Type 1 DM * Avoid: Barely, Rye, Wheat
28
Lactose intolenrance Cause/Sx/Dx/Tx
* Cause: lack of lactase enzyme * Sx: bloating flatulence, **No weight loss** * Dx: hydrogen breath test * Tx: Avoid dairy product, lactose free diet, Calcium supplement
29
Nut allergy Cause/MC type/Tx/Special comment
* Cause: IgE mediated reaction * MC type: Dermatologic * Tx: avoidance, if severe epinephrine * MC food type related anaphylaxis
30
Gastritis Cause/Sx/Dx
* Cause: H pylori MC, NSAID, Stress * Sx: Epigastric pain * Dx: Endoscopy * Tx * Positive H pylori - CAP (clarithromycin + AMOX + PPI) * Negative H pylori - PPI, H2 blocker
31
Peptic ulcer disease Cause/Sx/Dx/Tx
* Cause: H pylori MC, NSAID, Zollinger ellison syndrome * Sx * epigatric pain worse at night * Food in pain gets better - duodenal * Food in pain gets worse - gastric * Dx: Endoscopy (best) * Urea breath test * H pylory stool test * Tx * H pylori positive: CAP (clarithromycin + AMOX + PPI) * 4 meds: bismuth + PPI + tetra + Metro * H pylori negative: H2 blocker or PPI * Special comment: **MC cause of upper GI bleed**
32
Pyloric stenosis Cause/Patient/Sx/PE/Dx/Tx
* Cause: autosomal dominant * Risk: Macrolide, first baby * Patient: infant (2 week- 2month) * Sx: Non-bilious projectile vomitting * PE: RUQ Olive shape mass * Dx: US (target) * Lab: Hypokalemic, Hypochloremic (Malka) * Tx: surgical
33
Hepatitis Type/Route/Dx/Tx
Hep A * Route - oral fecal **(Only A has Spike fever)** * Dx: Hep A IgM - actue, IgG - recovery * Tx: supportive Hep B * Route - sex or needle * Dx * HBsAg - any active infection (Acute or chronic) * Anti-HBs - recovery or immune * Anti IgM - Acute * Anti IgG - chronic or recovery * Tx: Supportive Hep C * Route - Blood - borne * Dx: HCV, **Screening for HCC via serum alpha feto** * Tx: interferon Hep D * Route: blood borne, **requires Hep C** Hep E * Route: Oral fecal * Dx: IgM * Tx: none (**highest mortality during pregnancy 3rd**)
34
Lab for liver injury Explain
* AST/ALT 2:1 ratio - ETOH * ALT\> AST 1000 difference - Acute hepatitis * ALP, GGT elevated - hepatic, billiary (PBC, PSC)
35
Fulminant Hepatitis Cause/Sx/Dx/Tx
* Cause: Acetaminophen MC * Sx: Encephalopathy (AMS, asterixis) * Dx: Ammonia elevated, PT/INR \>1.5 * Tx * Encephalopathy - lactulose * protein stop + abx (neomycin) * Liver transplant definitive
36
Cirrhosis Cause/PE/Dx/Tx
* Cause: ETOH * PE: acities, encephalopathy, esophageal varices * Dx: US * Tx * Encephalopathy - lactulose * Ascities - Na stop * Pruritis - Cholestyramine * Fluid remove - Spironolactone
37
Peritonitis Cause/Sx/Dx/Tx
* Cause: Portal HTN -\> edema -\> bacterial infiltrate (E coli) * Sx: Fever * Hx: Cirrhosis * PE: Acities, fluid wave * Dx * PMNs \> 250, WBC \> 1,000 * Analysis fluid * Tx: IV abx
38
Hernia Direct vs indirect location/patient/Tx
* Location * Indirect - pass into scrotum * Direct - Do not extend into scrotum * Hasselbach's triangle (inferior epigastric vessel,inguinal ligament, Rectus abdominus muscle) * Patient: less than 1 yo or more than 40 yo * Tx * Stage 1 - soft and able to reduce * Stage 2 - firm and painful * Stage 3 - strangulated (painful and impaired blood flow)
39
Noninvasive diarrhea vs invasive diarrhea Pathgen/sx difference
* Noninvasive - Staph A, Cholera, E coli, C Diff, bacillus * Invasive - Salmonella, Campylobacter, shigella, salmonella, yarsinia, E coli 0157 * Sx: * Noninvasive - watery, No WBC * Invasive - bloody, WBC high
40
Noninvasive Pathogen/Source/Sx/Tx
* Bacillus - fried rice in 6 hrs * Sx: N/V/D * Tx: Fluid * Staph A - mayo, custard in 6hrs * Sx: N/V/D * Tx: Fluid * Cholera - contaminated food or water (3rd world country) * Sx: Severe water loss (Rice water stool) * Tx: Fluid, Cipro (tetracycline) * E coli (traveler) - other underdevelop country * Sx: N/V/D * Tx: Fluid, Cipro (pregnancy - AZA) * C Diff - Normal flora, clindamycin * Sx: high lymphocytosis * Tx: Vancomycine Oral, Severe IV Vanco
41
Invasive Pathogen/Source/Sx/Dx/Tx
* Campylobacter - undercooked poultry (chicken) **3day incubation** * Sx: initially water -\> become bloody diarrhea * Dx: stool culture (seaful shape) * Tx: Erythromycin * Shigella - oral fecal contamination * Sx: Explosive initially water -\> become bloody diarrhea * Dx: Stool culture (1st), sigmoid (punctate ulcer) * Tx: Fluid, Bactram * Salmonella - poultry product **6-48 hrs** * 2type * Gastro(typhim) vs thyphid (typhi) * Sx * Gastro - bloody diarrhea * Thyphoid - bradycardia, pea soup stool * Tx: Fluid, Cipro (Sickle cell must get abx - osteomyelitis) * E Coli 0157 - ground beef * Sx: bloody diarrhea * Tx: Fluid * Abx may cause HUS in children * Yersinia - undercook pork * Sx: mimic acute appendicitis (right lower quadrant tenderness) * Tx: Fluid
42
Giardia Source/Sx/Dx/Tx 1. Which diarrhea has amebic liver abscess? Tx? 2. AIDs related diarrhea? 3. Osmotic gap high vs osmotic gap low? 4. Most common diarrhea in children? 5. MC gastro virus in cruise ships?
* Giardia * Source - water stream and well * Sx: frothy, greasy foul diarrhea * Dx: stool culture * Tx: Metronidazole 1. Amebiasis, Tx: Metronadazole 2. Cryptosporidium 3. Gap high - Osmotic, Gap normal - secretory (motility) 4. Rotavirus 5. Novovirus
43
Ingesting toxic 1. Acetaminophen 2. Anticoagulants 3. Benzodiazepine 4. BB 5. ASA 6. Opioids 7. TCA (amitriptyline)
1. N-acetylecysteine 2. FFP, Vit K 3. Flumazenil 4. Insulin, glucagon 5. Sodium bicarbonate 6. Naolxone 7. Sodium bicarbonate
44
G6PD deficiency Cause/Patient/Sx/Hx/Dx/Tx
* Cause: X linked recessive * Patient: AA male * Sx: Anemia, splenomegaly * Hx: taking Sulfa, antimalarial, nitrofurantoin * Dx: Heinz body * Tx: self-limited
45
Paget vs osteomalcia vs Ricket Cause/Sx/Dx/Tx
Paget * Cause: Osteoclast work a lot become larger but weaker * Sx: Asymptomatic * Dx: high ALP, X-ray (blade of glass) * Tx: Bisphosphonates (slow osteoclast) Osteomalacia (adult), Ricket (children) * Cause: Vit D deficiency (soft bone) * Sx: Bowing of long bone, **Ricket - Fontanell closer slow, Growth retardation** * Dx: Low Vit D, X-ray (loose line) * Tx: Vit D
46
Phenylketonuria Cause/Sx/Dx/Tx
* Cause: autosomal recessive (deficiency of Phenylalanine hydroxylase) * Dx: musty urine and oder * Tx: life time phenylalanine diet (milk, egg, meat, chicken, aspartame (diet soda))
47
Colorectal cancer Cause/Sx/Dx/Tx/Screening
* Cause: FAP (familial adenomatous polyposis) * Sx: Bleeding, bowel obstruction (constipation) * Dx: Colonoscopy * Barium - apple core lesion * CEA test high * Tx: Surgical * Screen: 50yo start Q10y, flex Q5y * 1st degree relative \>60y - 40y Q10y check * 1st degree relative \<60y - 40y Q5y
48
Pancreatic carcinoma Cause/MC type/Sx/PE/Dx/Tx
* Cause: Smoking + \>60y * MC type: Adenocarcinoma ductal * Sx: painless jaundice + weight loss * PE * Palpable nontender gallbladder (courvoisier sign) * Trousseau’s syndrome - migratory thrombophlebitis * Palpable left supraclavicular lymph node (Virchows node) * Palpable nodule bulging into the umbilicus (Sister Mary Joseph sign) * Dx: CT(1st), CA19-9 * Tx: whipple procedure
49
Hepatocellular carcinoma Cause/Dx/Tx
* Cause: Chronic Hep B,C,D * Dx: US, alpha fetoprotein * Tx: Surgical remove
50
Gastric carcinoma Cause/MC type/Sx/Dx/Tx
* Cause: H pylori * MC type: Adenocarcinoma * Sx: Weight loss, pain, bleeding * PE * Left supraclavicular (virchow) * Left axillary (Irish) * Periumbilical node (sister mary joseph's node) * Dx: Endoscopy w/ bx * Tx: Surgical remove, chemo
51
Esophageal cancer Cause/Sx/Dx/Tx
* Cause: continue GERD sx * MC type: Adenocarcinoma (upper 1/3 part) * Risk: Smoking, alcohol * Sx: Weight loss, pain with solid food * Dx: Endoscopy w/ bx * Tx: Surgical remove, chemo
52
Vitamin deficiency Vit A/B/C/D/K Medication blocks vitamine absorption?
* Vit A * Night vision blindness, bitot spot (keratin (rough) conjunctiva) * Hypervit A - tetragenicity, papilledema, alopecia, HA * Vit B​ * B1 (thiamine) - **MC ETOH** * Wernicke AGO - ataxia (gait blance broke), global confusion, opthalmoplegia (abnormal eye muscle) * Korsakoff's dementia - short term memory loss * B2 (riboflavin) * Oral (angular cheilitis), ocular, genital syndrome * B3 (niacin) * 3D (pellegra) - diarrhea, dementia, and dermatitis * B6 (pyridoxine) * Peripheral Neruopathy - INH * B12 (cobalamin) * Patient: Vegan, hx of gastrectomy (parietal cell), ETOH * PE: pallor and glossitis * Dx: MCV \> 100, hypersegmented neutrophils, elevated homocysteine, elevated methylmalonic acid * Tx: IM or oral Vit B12 * Vit C (ascorbic acid) - lack of citrus fruits and green vegetable * Scurvy 3 H - hemorrage, hyperkeratosis, hematologic * Vit D - lack of sun exposure * Rickets, osteomalacia * Vit K * low coagulation factor leads to increased bleeding and PTT PPI blocks vitamine absorption should separated each other
53
Refeeding syndrom Cause/Lab/Tx
* Cause: Starvation lead hypophosphatemia and refeeding demand more phosphate -\> severe hypophosphatemia * Lab: HypoK, HypoMg * Complication: HF or dysrhythmias * Tx: slowly replenish
54
Acute Pancreatitis Cause/Sx/Dx/Tx/Ranson's criteria
* Cause: Gallstone (1st), ETOH (2nd) * Sx: epigastric pain radiate to the back * PE: Gery turner sign (left flank eccymosis), Cullen (umbilical eccymosis) * Dx * If billirubin is high - gallstone cause US (1st choice) * If billirubin is not high - CT (initial) * Lipase (best), amylase elevated * Tx: IV fluid * Ranson's criteria * Age 55\< * WBC 16000\< * LDH 350\< * AST 250\< * Glucose 200\<
55
Chronic Pancreatitis Cause/Triad/Dx/Tx
* Cause: ETOH * Triad: Calcification, steatorrhea, DM * Dx: X-ray (Calcification), **Lipase and amylase NOT elevated** * Tx: Pancreatic enzyme replacement
56
Appendicitis Cause/Sx/PE/Dx/Tx
* Cause: Fecalith * Sx: pain start with periumbilically then moved to RLQ * PE * Rsoas sign - hip extension pain * Obturator - knee flex and rotate pain * Rovsing - LLQ push, pain RLQ * Mcburney - RLQ pain * Dx: US (1st), CT * Tx: appendectomy * Post op lab: Hypokalemia
57
Intussusception Cause/Patient/Sx/Dx/Tx
* Cause: tumor, mechel's diverticulum * Patient: Children * Sx: colicky abd pain (currant jelly like blood stool) * Dx: US (target) * Tx: Air contrast enema
58
Small bowel obstuction Cause/Hx/Sx/Dx/Tx/
* Cause: adhesion * Hx: surgery * Sx: vomitting * Dx: CT (best) X-ray (dilated bowel, air fluid level in step ladder pattern) * Tx * Nonstrangulated: NGT, bowel rest, IV fluid * Strangulated: surgery
59
Meckel's diverticulum Rules of 2/Sx/Dx/Tx
* Rules of 2: 2 feet from ilocecal valve, 2 yo, 2 inch long, 2% population * Sx: Painless rectal bleeding * Dx: Meckel's scan * Tx: surgical if sx
60
Ogilvie syndrome Cause/Dx/Tx
* Cause: Massive dilation w/o mechanical obstruction * Dx: CT * Tx: neostigmine
61

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