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Review course > GI > Flashcards

GI Flashcards

1
Q

Most common causes of Chirrosis

A

Alcoholic liver disease

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2
Q

Other causes of chirrosis

A

hepatitis, drug toxicity

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3
Q

Signs of chirrosis on exam

A

hepatomegaly, palmar erythema, spider angiomas, caput medusa, vitamin deficiency

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4
Q

Major cause of GI bleeding in a ptient with chirrosis

A

Varacies

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5
Q

What shows late advance liver disease

A

PT- INR (will be elevated)

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6
Q

What is chirrosis

A

fibrosis and widespread nodules - fibrosis replaces dead or damaged hepatocytes

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7
Q

What is the gold standard for dignosis of chirrosis

A

liver biopsy

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8
Q

How to treat chirrosis

A

BB, fluid restriction, diuretics, low salt diet, treat anemia and other vitamin deficencies (vit K replacment), limit protein

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9
Q

what is the risk of TIPS

A

stenosis and increase in cases of encephalopathy

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10
Q

what is TIPs good for

A

esophageal varicies

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11
Q

cause of acities

A

portal HTN and hypoalbuminemia

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12
Q

Common infections in acities

A

E. Coli, klebsiella and strep pneumoccoccus

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13
Q

How does lactulose work

A

osmotic diarrhea

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14
Q

complications of liver failure

A 
AC 9H
Acities
Coagulopathy
Hypoalbuminemia
Portal Hypertension
Hyperammonemia
Hepatic encephalopathy
Hepatorenal syndrome
Hypoglycemia
hyperbilirubinemia (jaundice)
Hyperestrinism
Hepatocellular carcinoma
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15
Q

I have yellow rings around my cornea and slight AMS

A

Wilsons disease

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16
Q

Cause of wilsons diasese

A

autosomal recessive - retains copper

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17
Q

I have diabeties and ruddy colored legs and arthralgias

A

Hemochromatosis

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18
Q

Cause of Hemochromatosis

A

autosomal recessive - iron absoption is increased

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19
Q

Complications of hemochromatosis

A

Chirrosis, cardiomyopathy, diabeties, arthritis, hypogonadism, hyothyroidism and suntan bronze appearace

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20
Q

Treatment of wilsons disease

A

chelating agents- penicillamine

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21
Q

definitive tx of wilsons disease

A

liver transplant

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22
Q

Tx for hemochromatosis

A

phlebotomy

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23
Q

diagnosis for hemochromatosis

A

liver biopsy

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24
Q

Iron tests in hemochromatosis show

A

low or normal TICB, High ferritin and high transferritin

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25
Q

3 common cancers that go to the liver

A

Colon, breast, lung

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26
Q

MCC of hepatocellular carcinoma

A

chirrosis

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27
Q

exam of a patient with suspected hepatocellular carcinoma

A

painful hepatomegaly

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28
Q

An elevted alpha fetoprotein is consistent with what cancer

A

liver

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29
Q

diagnosis of liver disease

A

biopsy

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30
Q

Gilberts is…

A

autosomal dominant with high unconjugated bilirubin

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31
Q

symptoms of gilberts disease

A

normally asymptomatic

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32
Q

What bilirubin level in the blood do you need to be jaundiced

A

3

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33
Q

common cause of liveer abcess

A

entamoeba hystolytica

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34
Q

MCC of pyogenic liver abcess

A

obstruction

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35
Q

a very sick patient presents with a hgh WBC, LFT’s and ESR tenderness in RUQ and jaundice

A

liver abcess

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36
Q

treatment of amebic liver abcess

A

flagyl

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37
Q

what is budd chari syndrome

A

a thrombosis to the hepatic vein that leads to ischemia

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38
Q

possible causes of budd chiari

A

hypercoaguable states

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39
Q

diagnosis of budd chairi

A

doppler us/direct venography (gold standard)

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40
Q

treatment of budd chiari

A

diuretics, TIPS

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41
Q

major causes of jaundice

A

hemolysis liver disease and billiary obstruction

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42
Q

conjugated is whay type of bilirubin

A

direct- water soluble

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43
Q

what bilirubin is detected in the urine

A

only in conjugated!!

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44
Q

what bilirubin can cross theblood brain barrier

A

indirect

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45
Q

indirect is what type of bilirubin

A

unconjugated

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46
Q

common cause of conjugated hyperbilirubinemia

A

hepatocellular disease, drug induced (OCPs), Gallstones, , PSC

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47
Q

Common cause of indirect hyperbilirubinemia

A

HEMOLYTIC ANEMIA, gilberts, drugs (abx), physiologic jaundice,

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48
Q

I have jaundice and grey colored stools

A

direct hyperbilirubinemia

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49
Q

AMA is seen in

A

PSC

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50
Q

SMA

A

autoimmune hepatitis

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51
Q

what test is more liver specific AST or ALT

A

ALT

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52
Q

I have an AST:ALT ratio of 2:1 why

A

Im an alcoholic

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53
Q

most common type of gallstones

A

mixed

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54
Q

Cholestatic LFTs are

A

alk phos, bilirubin (AST and ALT are not really elevated)

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55
Q

If alk phos is elevated what should you check

A

GGT- liver specific

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56
Q

screening test for cholecystitis

A

U/S-

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57
Q

common U/s findings for cholecystitis

A

stones, thickened gallbladder wall, pericystic fluid

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58
Q

What is a HIIDA scan

A

dynamic study of bile flow

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59
Q

where else does alk phos come from

A

bone, placenta

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60
Q

what LFT’s thatare associated with liver and not gallbladdre

A

AST and ALT

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61
Q

what is boas sign

A

referred right subscapular pain

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62
Q

what is the most sensitive test for stones in theCBD

A

ERCP

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63
Q

murphes sign

A

Inspiratory arrest with deep palpation of the RUQ

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64
Q

What is choledocalothiasis

A

stone in the CBD

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65
Q

Charcots triad

A

fever, RUQ pain and jaundice

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66
Q

someone with mono has jaundice - why

A

elevated AST and ALT

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67
Q

reynolds pentad

A

feer, RUQ pain, jaundice and septic shock and AMS

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68
Q

What is Primary sclerosising cholangitis associated with

A

UC

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69
Q

most common presenting symptoms of PSC

A

jaundice and puritis

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70
Q

common carcinogenic complication of PSC

A

cholangiocarcinoma - 20-30%

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71
Q

diagnosis of PSC is made by

A

ERCP

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72
Q

only curative tx for PSC

A

lover transplant

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73
Q

Marker for PSC

A

ANCP antibodies

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74
Q

you see a sting of beeds on ERCP - why

A

PSC

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75
Q

If patients need tx for puritis -

A

cholestiramine

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76
Q

Primary billiary chirrosis is what

A

an autoimmune disease

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77
Q

Who gets PBC

A

Middle aged women

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78
Q

signs of PBC

A

fatigue, pruitis, jaundice, RUQ discomfort, xanthomas, osteoporosis

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79
Q

Most common type of cholangiocarcinoma

A

adenocarcinoma

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80
Q

/what is Klatskins tumor

A

proximal third f the CBD- most common

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81
Q

Diagnosis to cholangiocarcinoma

A

ERCP

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82
Q

most common presenting symptom of appendicitis

A

Periumbilical pain

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83
Q

Symptoms of appendicitis besides RLQ pain

A

anorexia, nausea, vomiting, pain with movment

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84
Q

how often are carcinoid tumors found in the appendix

A

5%

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85
Q

Diagnostic image for appendicitis

A

CT with oral and IV contrast

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86
Q

Most common cause of appendicitis

A

hyperplasia of lymphoid tissue (60%) Fecalith (35%)

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87
Q

obturators sign

A

pain in RLQ when flexed right thigh is inernally roated when patient is supine

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88
Q

psoas sigh

A

RLQ pain when right thigh is extended

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89
Q

I am hungry - do i have appendicitis

A

probably not

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90
Q

Rosvings sign

A

deep palpation of the LLQ produced pain in the RLQ

91
Q

cause of carcinoid tumor

A

serotonin syndrome

92
Q

MCC of acute pancreatitis

A

alcohol

93
Q

Other cause of acute pancreatitis

A

hypertryglyceridemia , gallstones, trauma, ERCP

94
Q

ecchymosis of the flanks

A

gery turners

95
Q

ecchymosis of umbilicus

A

cullens

96
Q

What is more definative for pancreas lipase or amylase

A

lipase

97
Q

what lab value may be low in pancreatitis

A

calcium - can be hypocalcemia

98
Q

what does ransons criteria consist of

A 
glucose >200
age>55
LDH>350
AST>250
WBC>16,000
99
Q

a amylase 5x the upper limit of normal is….

A

acute pancreatitis

100
Q

Most important treatmetn for pancreatitis

A

IVF replacment and correct electrolyte abnormalities

101
Q

most accurate way to diagnose pancreatitis

A

CT scan

102
Q

pain control for pancreatitis

A

fentanyl and meperidine

103
Q

Gold standard for chronic pancreatitis

A

ERCP

104
Q

MCC of chronic pancreatitis

A

alcohol

105
Q

triad for chronic pancreatitis

A

steatorrhea, diabetes, calcification of pancreas on plain film

106
Q

treatment of chronic pancreatitis

A

H2 blockers and pancreastic enzymes

107
Q

Most common typeof pancreatic cancer

A

adenocarcimoma

108
Q

most common location for pancreatic cancer

A

head (75%)

109
Q

what is courvoisiers sign

A

palpable gallbladder

110
Q

what is the best dignostic imaging for pancreatic cancer

A

ERCP/biopsy

111
Q

most common cause of lower GI bleed

A

diverticulosis

112
Q

UGI bleeding is locates where…

A

above the ligament of tritz

113
Q

can upper GI bleed present with bright read blood per rectum

A

yep- if it is a swift

114
Q

melena

A

small intestine or ugib (90%)

115
Q

coffee ground emesis

A

PUD

116
Q

what are other causes of darkstools

A

bismouth, iron, spinach, charcoal, licorice

117
Q

high BUN/Cr ratio could mean

A

GIB

118
Q

UGIB diagnosis

A

endoscopy

119
Q

melena diagnosis

A

endoscopy

120
Q

hematochezia diagnosis

A

colonoscopy

121
Q

What are alarm symptoms

A

dysphagia, odonophagia, weight loss, anemia

122
Q

Medication induced espohagitis is commonly caused by

A

tetracyclines, NSAIDS abd alendronate

123
Q

Common infectious causes of Esphagitis

A

Candida, HSV, CMV

124
Q

most common cause of infectious espophagitis

A

Candida

125
Q

a 23 year old male presents with dyphagia and gerd that is refractory to PPIs what is the likley cause

A

Eosinophilic esophagitis

126
Q

what is zenkers diverticulum

A

an outpouching of the weakest point in the pharynx due to excess pressure below it

127
Q

a patiet presents with intermittent dysphagia with solid foods and regurgitation of undigested foo…

A

zenkers diverticulum

128
Q

diffuse esophageal spasm is also known as

A

nutcracker esophagus

129
Q

treatment modalities for DES

A

CCB, tricyclic antidepressants, botox and nitrates

130
Q

a patient presents with dysphaggia to both solids and liquids and is found to have a bird beak on barrium swallow

A

acgakasua

131
Q

a patient presents with dyphagia to solids to liquids

A

esophageal carcinoma

132
Q

MCT of esophageal carcinoma

A

SCC (90%)

133
Q

Esophageal carcinoma caused by barrets esophagus/untreated GERD

A

Adenocarcinoma

134
Q

Common risk factors for esophageal SCC

A

drinking, smoking, african american, male

135
Q

location of SCC ofthe esophagus

A

upper 2/3s

136
Q

Location of adenocarcinoma of the esophagus

A

lower 1/3

137
Q

risk factors for adenocarcimona aof the esophagus

A

barrettes and GERD

138
Q

Most Common symptom of esophageal carcinoma

A

dysphagia

139
Q

this occurs from reflux causing stricture of the distal esophagus

A

schatzki ring

140
Q

what is plummer-vinson syndrome

A

constriction of the upper esophagus due to iron deficiency anemia

141
Q

a tear at the gastroesophageal junction is also called

A

mallor-weis tear

142
Q

Whatis the treatment for a mallor weis tear

A

most will heal on their own

143
Q

esophageal varicies are small if they are under what size

A

5mm

144
Q

how is active bleeding of esophageal varicies treated

A

octreotide and a fluroquinalone

145
Q

MCC of dysphagia

A

idiopathic

146
Q

MCC of gastritis

A

NSAIDS

147
Q

I have an ulcer that mproves with meals

A

duodenal

148
Q

I have an ulcer thaat gets worse with meals

A

peptic

149
Q

PUD MCC

A

H. Pylori

150
Q

Long term consequencess of H pylori ifection

A

gastric cancer, malt lymphoma (Non-hodgkins lymphoma)

151
Q

treatment of H pylori

A

PPI, clarithromycon and flagyl or amoxicillin

152
Q

MC gastric caancer

A

adenocarcinoma

153
Q

what is the most common PE finding in gastric carcinoma

A

a palpable mass

154
Q

Risk factors for gastric carcinoma

A

H. Pylori(#1), smoking, drinking

155
Q

a 3 month old male presents with non-bilious progectile vomiting after feeding

A

pyloric stenosis

156
Q

physiologic finding on pyloric stenosis

A

hypertrophy of the pyloris

157
Q

physical exam will demoonstrate what in pyloric stenosis

A

olive shaped mass in the epigastric region

158
Q

what metabolic abnormality is commonly found in children with pyloric stenosis

A

hypochloremic alkalosis and hypokalemia

159
Q

barrium swallow will demonstrate what finding with pyloric stenosi

A

string sign

160
Q

what is the test of choice forcholangitis

A

ERCP- both diaagnostic and theraputic

161
Q

What hepatitis’s are transmited through the fecal oral route

A

A+E

162
Q

What hepatitis’s are transmited through bodily fluids

A

B, C, D

163
Q

What 2 hepatitis are transmitted together

A

B+D

164
Q

wwhat LFTS will be elevated in hepatitis

A

AST and ALT (just in the liver not the cholestatic liver)

165
Q

what is an accurate predictive test for liver function in a pt with hepatitis

A

PT- elevated is worse

166
Q

common tx of hp b and c

A

interferon

167
Q

in advanced chirrosis what is the AST and ALT values

A

Normal- bc ost of the liver isnt working so it is still high but not from as many hepatocytes

168
Q

what is

fox sign

A

ecchymosis of the inguinal ligament

169
Q

an elevated BUN can be seen in what type of GIB

A

Upper!

170
Q

You do an endoscopy and see salmon colored tongue like projections on my esophagus why

A

barretts esophagus

171
Q

What area does celiac disease affect in the body

A

small intestine

172
Q

I have diarrhea bloating weight loss and abdominal pain… what could i have

A

celiac

173
Q

Best lab study for celiac

A

IgA- tTG (tissue transglutaminase)- can also do a endomysial antibody

174
Q

gold standard for celiac

A

duodenal biopsy

175
Q

what will a biopsy show in celiac

A

villous atrophy

176
Q

tx for celiac

A

gluten free

177
Q

MCC of achalasia in the US

A

idopathic

178
Q

MCC of achalasia in the world

A

chagas disease

179
Q

what is it called when a periumbilical node is palpable due to metastasis from GI carcinoma

A

sister mary josephs node

180
Q

what is it called when a supraclavicular node is palpable due to metastasis from GI carcinoma

A

virchows node

181
Q

MCC of SBO

A

adhesions

182
Q

MCC of LBO

A

colon cancer

183
Q

I just had surgery and now I cant poop…why

A

paralytic Illius

184
Q

transmural thickening and inflammation

A

chrons

185
Q

messenteric fat creeping

A

chrons

186
Q

cobblestone appearance

A

chrons

187
Q

skip leisons

A

chrons

188
Q

Non-bloody diarrhea, weight loss, anemia and RLQ pain

A

Chrons

189
Q

This type of IBD always involves the rectum

A

UC

190
Q

This type of IBD most commonly involves the terminal illium

A

chrons

191
Q

uninterrupted involvement of the rectum and/or colon

A

UC

192
Q

inflamation of the mucosa and Submucosa

A

UC

193
Q

Crypt abscess

A

UC

194
Q

I hve bloody diarrhea, abdominal pain and tenesmus

A

UC

195
Q

treatment for IBD that is commonly used as a suppository

A

sulfasalazine

196
Q

when the colon is involved in IBD we use

A

5 ASA (mesalamine)

197
Q

we use _______________ in acute exacerbations of IBD

A

Steroids

198
Q

How is diverticulosis diagnosed

A

colonoscopy

199
Q

how is diverticulitis diagnosed

A

CT- dont do a colonoscopy

200
Q

tx for diverticulosis

A

nut and seed avoidance, diet high in fiber and water

201
Q

tx for diverticulitis

A

augmentin or cipro+flagyl

202
Q

inpatient tx for diverticulitis

A

ampicillin/sulbactam, pipercillin/tazobactam

203
Q

how long after treatment of diverticulitis do you preform a colonoscopy

A

6 weeks

204
Q

pt with IBD that is pANCA positive

A

UC

205
Q

Pt with IBD that is ASCA positive

A

Chrons

206
Q

a pt with chrons fails treatment woth 5- ASA what now

A

flagly or cipro

207
Q

Intussusception is most commonly seen in what age group

A

less than 1 year

208
Q

classic triad for intussesception

A

colicy abd pain, curany jelly stool, and palpable mass in TUQ (sausage shaped mass)

209
Q

Tx for intisesception

A

air enema

210
Q

abd pain relieved by defcation during the day

A

IBS

211
Q

pain out of proportion to exam

A

ischemic bowel disease

212
Q

gold standard for ischemic bowel disease diagnosis

A

cta

213
Q

colonoscopy screening guidelines

A

start at 50 end at 75 q 10 years

214
Q

what is borchadts triad and what is it used for

A

abd pain, vomiting and inability to pass ng tube– gastric volvulus

215
Q

how much is the colon dialated in toxic megacolon on plain film

A

6 cm

216
Q

infectious diarrhea that begis within 6 hours

A

staph or baccilus cerus

217
Q

appendicitis prentation without appendicitis

A

yersinia enter

218
Q

Infectious diarrhea (ID) and chicken and eggs

A

salmonella

219
Q

ID and shellfish

A

vibrio

220
Q

ID and cramping and infected fresh water

A

giardia

221
Q

ID and canned foods

A

clostridium

222
Q

ID and daycare

A

shigella

223
Q

ID and poultry and raw milk

A

camppylobacter

224
Q

I have giardia treat me

A

flagyl

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