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GI Flashcards

1
Q

Tongue -

Sensory?
Taste?
motor?

A

Sensory - 5-9
Taste 7-9
Motor 12

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2
Q

Esophageal lymph node sections?

A

Cervical;
mediastinal
celiac/gastric

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3
Q

Types of mouth CA

Pleomorphic adenoma

Warthin

Mucoepidermodi

A

Pleomorphic adenoma - benign - “Chondromyxoid” - Odd borders, Recurrs after surgery.

Warthins - Bening, Cystic w/ GERMINAL CENTER. Papillary cystic.

Mucoepidermal - Malig - Mucous+ Squamous

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4
Q

Torus palatinus - Presentation? Tx?

A

hard midline immobile mass in superior palate.

No tx unless sx

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5
Q

Retropharyngeal abscess - Radiographic findings?

Concerns?

A

Widened prevertebral space -> concern mediastinal infection

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6
Q

Leuk/Erythroplakai?

What to do? Concners?

A

Biopsy both. NOT SCRATCHABLE off

E> L risk factor for SQUAMOUS CCA

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7
Q

Esophageal perf - dx?

A

Water soluble esophagram.

May be iatrogenic, after biopsy

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8
Q

Ludwig Angina -location, from where?

A

Submandible, sublingual - from molars.

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9
Q

Toxic ingestions - workup algorithm?

A 
Serial CXR (for perth)
Endoscope w/in 24 hours -
Follow up sx w/ water sol esophagram
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10
Q

Variceal Hemorrhage - Tx algorithm?

A

IV fluids, octreotide, Ceftriaxone. BB is long term

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11
Q

Mallory weight etiology of tear?

A

Submucosal artery at distal esophagus, proximal stomach

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12
Q

Duodenal hematoma tx?

A

NG and TPN - no abx

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13
Q

Causes of acute gastritis?

A

UREMIA, Stress, NSAIDS, ETOH, Burn, Brain.

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14
Q

Chronic Gastric - location and etiology. Risk factors?

TA
TB

A

A - Fundus, Body, Autoimmune

B - Antrum - Bacterial. INC risk of MALToma (tx h pylri) ADENOCA.

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15
Q

Menieres - presentation?

Concerns?

A

Hypertrophy, protein loss. INC mucous, DEC parietal cells.

Premalignant

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16
Q

Peptic Ulcers - Locations? Types? Locations

A

90% duodenoal (ok), Gastric are the concerns

intestinal - Lesser curve - H pylori - Chronic Type B
Diffuse - non H pylori. SIgnet. Linnus plastic. Krukenberg

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17
Q

VIPoma - locations?

Vs

Carcinoid?

A

VIPoma - pancreas

Carcinoind - Ileum/small bowl

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18
Q

Dumping syndrome? When? Presentations?

Tx?

A

Autonomic signs, flushing, fainting,

Occurs post gastrectomy>

Change Diet first.
Refractory -> Octreotide -> surgery

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19
Q

Sites of Fe, Folate, B12 abs?

A

Fe - duodenum
Folate - Jej
B12 - ileum

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20
Q

Acute mesnteric Ischemia - lab findings?

A

INC lipase, INC lactate, METABOLIC ACIDOSIS.

AKA can mimic pancreatits . Look for athero risk factors

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21
Q

Chronic mesenteric ischemia presentation?

A

Worse wi th food. 50% have abd bruit

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22
Q

Chronic pancreatitis - presentation?

A

Pain with no relief from antacids . Intermittent pain.

Dx - CT scan - may show calcifications

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23
Q

Trousseau sign - presentation, etiology, concnerns

A

Mig thrombophlebitis, Hypercoag state.

Pancreatic CA.

CT Abd.

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24
Q

Pancreatic CA screening biomarker?

A

CA 19-9

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25
Q

Crohns vs UC

A

Crohns
-Th1, granulomas, creeping fat, kidney stones.
tx - steroids, MTX, infliximab

UC

  • No granulomas (Th2) - Lead pipe sign, PSC, P ANCA
  • Tx 5ASA, 6MP, Inflix, Colectomy
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26
Q

Tx IBD related toxic megacolon?

A

Abx + STEROIDS

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27
Q

P biliary Cirrhosis

VS

P Sclerosing CHolangitis

A

PBC

  • Crohns, granulomas, female night, pruritis.
  • INTRA hepatic. Vanishing duct, ductopenia
  • Anti-Mitochondrial
  • Crest, sjogrens, Celiac, RA
  • Tx ursodeoxycholic

PSC

  • Fibrosis, onion skinning, beading.
  • p ANCA
  • Intra and extra hepatic
  • ~Hyper IgM, UC, CHOLANGIOCA
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28
Q

Dx and histo

Lactose

vs

Celiac – risk?

A

Lactose - normal villi
- H breath test, INC stool reducing agents, DEC stool pH. INC osmotic gap

Celiac - blunted villi.
Ab - TTG, gliadin, endomysial. Dq28, TH mediated.
- Riks - T CELL LYMPHOMA

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29
Q

Tropical sprue - similar to ? tx?

A

Celiac – responds to abx though

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30
Q

Abeta - histo

presentation?

A

Abeta - fat in enterocytes. DEC APoB

Night blindness, steatorrhea, ATAXIA

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31
Q

Pancreatic insufficiency - dx?

A

D -xylose test ( doesnt need enzymes to be abs)

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32
Q

How to test for ZE, gastrinoma?

A

Secretin test. Usualyl it shoudl DEC gastring.

But in ZE it INCREASE gastrin.

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33
Q

Small bowel bacterial overgrowth - presentation?

dx?

A

Malabs, steatorrhea, bloating, flatulence, weight loss

Anatomic dysmotility.

Jejunal aspirate shows >10^5 microbes.

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34
Q

Schilling test - pathways and findings

A

B12 abs

1 - IM + PO = if in urine - dietary. If not in urine, was not abs

2 - PO + IF
-in urine = pernicious anemia
not in urine - ileal disease.

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35
Q

Who to suspect pernicios anemia in?

A

Northern European w/ autoimmune conditions (vitiligo, thyroid etc)

36
Q

Polyps to be concerned w? 3 factors

A

Villous, Sessile (no stalk) , Greater than 2.5cm

37
Q

FAP - inheritance, chr, gene problem

special subtypes

A

FAP - AD, APC, Chr5,

Gardeners - FAP + osseous

Turcot - FAP + Malig CNS

38
Q

HNPCC lynch - genetic problem - concerns?

A

DNA mismatch - R colon -

Extrainteestinal CA! (endometriod)

39
Q

Peutz Jegher - inheritance - presentation - cocners.

A

AD - Nonmalig hamartomas + hyperpig.

INC CRC risk !! (as a whole, not from hamartomas)

40
Q

Watershed sites in colon?

A

Splenic flexure

Rectosigmoid

41
Q

Liver
microvesicular vs macro?
centrilobular?

A

Microvescular - reyes

Macro - ETOH, Nash, N! Mallory bodies

Centrilobular necrosis - halothane

42
Q

Damage in hepatitis is from?

A

Cytotoxic T lymphocytes

43
Q

In clearance phase, how to monitor hepatitis?

A

e Ag and ALTs every 3-6 mo until cleared

44
Q

Hep B tx - when? with what?

A

DNA>20k, ALT x2
Short term - interferon (but really, Tenofovir!)
chronic - Tenofovir, entecavir

45
Q

Hep C - tx? requirements?

A

Compensated (fibrosis is okay)
Older than 18, INR less than 1.5, compliant. No active drug use or MDD.

peginterferon + ribavarin

geno1 add telaprevir, boceprevir

iF UNCOMPLICATED (inr > 1.5, DEC serum albumin -> liver tx)

46
Q

Hep C associated with what 4+?

A

Porphyria, cryoglobulinemia, Memb, Memprolieratve T1

47
Q

Etiology, tx, concerns.

Cavernous hemangioma -

Hepatic adenoma

Angiosarcoma?

A

Cavernous hemagnioma - common, benign, DO NOT BIOPSY

Hepatic adenoam - OCP/steroids

Angiosarcoma - Arsenic, vinycl Cl, PECAM 31.

48
Q

Gilbert
Crig Najr

Dubin HJohns

Rotor

A

Gilbert, DEC UGT - largely asx

Crig Najr - T1 - NO UGT - plasmapx, photo

Crig Najr 2 - Not as bad - Tx phenobarbital

Dubin Johnson - DEC ability to excrete - INC Cbili, BLack liver

Rotor - INC Cbili, no black liver

49
Q

Cirrhosis - maintenance workup?

A

US and AFp every 6 mo

EGD every year

50
Q

Hepatorenal - etiology, presentation?

A

ESLD -> renal failure due to renal hyoperfusion.

Urine Na is less than 10 (good, prerenal picture)

Not corrected with IV fluids.

51
Q

Acute liver failure - presentation? causes?

best prognostic factor?

A

Encephalopathy, INR>1.5 WITHOUT PREEXISTING CIRRHOSIS

Hept, ETOH, tylenol, ischemic, wilsons

May see a dec in Transaminase (dec liver function)

PT is best prognostic factor

52
Q

WIlsons lab findings?

A

DEC ceruloplasmin

INC Cu urine excretion (only way to get it out)

53
Q

TPN - most feared complication. Other concerns.

A

catheter tip infection. Diarrhea is rare. Avoid Refeeding syndrome(HypoK,Mg, P ) by slow infusion and checking electrolytes.

54
Q

What should be given to someone s/p gastric bypass surgery?

A

ursodeoxycholic acid

55
Q

Is Peritoneal irritation somatic or visceral

A

it is somatic – it is sharp

56
Q

SAAG - what can it differentiate between

A

Serum – ascites.

If >1.1 suggests portal HTN (liver or not) aka INC hydrostatic pressure

If less than 1.1 suggests TB, Malignancy, Pancreatitis, Nephrotic disease

57
Q

SBP – tx alogithm

A

– broad abx (cef) – DO NOT DO LVP even if they have a lto of fluid onboard!

58
Q

Pancreatic CA – symptomatic bili and itching - what to do

A

Tx – palliative – endoscopic Common bile duct stent

59
Q

Esophageal spasm tx?

A

CCB

60
Q

Dyspshagia in HIV CD4

A

Empirically start fluconazole over endoscopy or biopsy.

61
Q

HNPCC - when to screen?

A

25 w.o colo every 1-2 years.

62
Q

PPx in variceal bleeding and ascites?

A

W variceal bleeding and ascites - need SBP ppx - TMP SMP.

After one episdoe fSBP - need lifelong ppx.

63
Q

Autoimmune hepatitis ab?

A

Anti smooth muscle antibody.

64
Q

If blood diarrhea – EHEC suspected, tx?

A

DO NO T GIVE ABX – INC RISK OF HUS!

65
Q

Acute cholangitis t x

A

supportive care and broad abx. If they do not respond, biliary drainage w/ ERCp

66
Q

gastric ulcer - what to do?

A

Biopsy must be performed on ALL gastric ulcers.

67
Q

Staging of Gatsric Adeno after biopsy?

A

ct abd pelvis

68
Q

Pathophys – Esophageal varices vs malloryWeiss

A

Varices- submucosal veins. Mallory Weiss – Submucosal ARTERIES

69
Q

Pleural effusion after thoracentesis in cirrhotic/ascetic pt – tx?

A

TIPS. Would reappear with chest tube and paracentesis is inadequate.

70
Q

Gallstones, opaque or radiolucent

A

Cholesterol and mixed stones are RADIOLUCENT – not visible on abdominal xray. Dotn confuse with kidney stones! This is why US and CT are used instead.

71
Q

Appendicitis

A

– Preop-Abx, NPO, lap appy (if classic, doesn’t require imaging as it may lead to perf; if nontypical, then CT or US). No post op Abx unless rupture

72
Q

INC Alk phosph

A

next step/? RUQ – assess intrahepatic or extrahepatic bili obstruction

73
Q

Achalasia vs Esophageal stricture

A

Ach: both soldis and liq. Stricture: Solid dysphagia. gerd complication, may actually improve gerd .

74
Q

Diarrhea vs vomiting metabolic findings

A

Diarrhea actually losses Bicarb leading to nongap ACIDOSIS. Vomiting alkalosis (saline responsive)

75
Q

Free air w/ history tx algorithim?

A

Urgent surgery consult. Emergent x lap. After CXR showing free air , no other imaging needed.

76
Q

Celiac disease can cause what heme issue with neg stool occult ?

A

Iron deficiency anemia due to malabsorption!

77
Q

When to use pancreatic protease inhibitors in pancreatitis?

A

Don’t use.

78
Q

Which pneumococcal immune is 40 y.o with liver failure?

A

PCV 23 – 13 is only for ICH/HIV, splenectomy, SS

79
Q

Where does D xylose get absorbed?

A

Proximal small intestine (NOT TERMINAL ILEUM)

80
Q

Can you treat Chronic Hep C? If considered for tx usu undergo

A

Yes, tx chronic hep c. undergo LIVER BIOPSY, best clinical predictor and assesses likelihood of response to tx. Those who have more cirrhosis/fibrosis usually respond better to tx.

81
Q

Manometry, achalasia vs systemic sclerosis

A

Achalasia INC tone, failure to relax. SS fibrosis and atrophy leads to hypomotility and incompetence of LES>

82
Q

Cholangitis workup

A

– medical emergency (Abx etc) with ERCP decompression. Not surgery.

83
Q

Acute diverticulutlits imaging?

A

DO NOT COLONOSCOPY, inc risk of perf. CT

84
Q

Pancreatic pseudocyst management

A

if painless DO NOT DRAIN, painful and greater than 6cm at 6wk, endoscopic drainiage.

85
Q

Pre-appy abx

A

Cipro and metronidazole ; amp/sulbactam; levofloxacin clinda. Cefotetan.

86
Q

Mesenteric ischemia w/ pain out of proportion to exam algorithm

A

surgery (embolectomy) or angio (thrombolyisi/vasodilators)

87
Q

Acute ascending cholangitis algorithm –

A

– IV abx ,emergent decompression of common duct w/ ERCP. Eventual cholecystectomy.

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