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Flashcards in ClinMed Deck (288):
1

what will a patient with ZE's fasting gastrin level likely be?

will be high (>1000) (usually <150)

2

two common forms of IBD?

Crohn's disease
ulcerative colitis

3

gold standard for dx of celiac dz

endoscopy with duodenal biopsies

4

procedures for hemorrhoids

minimally invasive: rubber band ligation, infrared coagulation, sclerotherapy, cryosurgery

5

what group of people are at increased risk for Whipple's?

farmers (animal waste/soil has more bacteria)

6

presence of the hep C antibody indicates what?

present or cleared infection

7

approximately 55% of UGIB are caused by ___?5 risk factors for this ?

peptic ulcers

NSAIDs, h.pylori, steroids, anti-coag, ethanol

8

treatment for SIBO

abx: rifaximin, cipro, metronidazole

9

free air under the diaphragm on CXR is indicative of what? seen in what dz?

perforation
diverticulitis

10

MC cause of chronic pancreatitis?

ETOH abuse (70%)

11

imaging modality of choice for acute pancreatitis

CT A/P w contrast (has to be w contrast)

12

what are the most common culprits of DILI?

acetaminophen, MTX, amiodarone

13

what is rome IV criteria for IBS?

recurrent abdominal pain at least 1 day/week in last 3 months associated w two or more of the following:
1. related to defecation
2. assoc w a change in stool frequency
3. associated w a change in stool for (appearance)

criteria fulfilled for last 3 months w sxs onset at least 6 mo b4 dx

14

if a patient has multiple uclers, what should you consider as a dx?

ZE

15

Diverticular disease is responsible for ~33% of what?is it painful?

lower GI bleeds

nope, (also usually on right side)

16

coffee ground emesis

blood from stomach or esophagus being digested/xidized in stomach/acid

17

tropheryma whipplei causes what rare, systemic disease

whipple disease

18

confirmation of eradication of h.pylori is recommended using what and after how many weeks?

urease breath test >4 weeks after tx is the test of choice

*serology will remain positive*

19

Ranson criteria is used for what?

acute pancreatitis, >3 =
severe pancreatic

20

first step in evaluating hematochezia is

pass a NG tube.
if negative for blood/bile, then colonoscopy
if anything else is found, EGD

21

what is cholelithiasis

gallbladder stones

22

in addition to PUD, what is a common clinical finding in ZE?
why?

diarrhea
increased acidity inactivates pancreatic enzymes that normally need a basic environment to become active. leads to malabsorption which leads to steatorrhea

23

dietary treatment for diverticulosis?

high fiber diet (want to prevent constipation)

24

choledocholithiasis definitive tx

ERCP

25

HBV DNA in the blood indicates what?

infection

26

scleral icterus is a finding of what ?

jaundice

27

bleeding during bowel movements (BRBPR) could indicate what dz?

hemorrhoids

28

celiac dz is commonly associated with what malignancies?

primarly adeno and lymphoma of the small bowel

29

what populations is non-alcoholic fatty liver disease (NASH) commonly seen in?

pts with metabolic syndrome: obesity, DM, hyperlipidemia, OSA, large waist

30

what is a mallory-weiss tear

bleeding from laceration in the mucosa (80-90% resolve on their own)

31

when is colon cancer risk increased in IBD?

if CD or UC affects >1/3 of colon (left - sided dz or greater)

32

gold standard for dx of PUD?

endoscopy (EGD)

33

what are the 3 principal stimuli of HCl secretion via the parietal cell?

1. g cell releases gastrin, stimulates ecl cells
2. ecl cells release histamine, stimulate parietal cells
3. enteric neurons release Ach, stimulate parietal cell

parietal cell releases HCl

34

are statins contraindicated in management of NASH?

NO! (these patients absolutely need a statin)

35

3 phases of digestion and absorption

1. intraluminal hydrolysis 2. digestion by brush border enzymes 3. lymphatic transport of nutrients

36

three pharm tx for IBS-D?

1. antidiarrheals (loperamide)
2. bile acid sequestrants (cholestyramine, colestipol)
3. 5HT3 receptor antagonists (alosetron) (more last line)

37

primary etiology/pathophys of GERD

transient relaxation/ incompetency of LES (lower esophageal sphincter

38

what symptoms might warrant a further work up for GERD?

dysphagia
wt loss
hematemesis
melena

39

what is sphincter of oddi dysfunction

abnormal LFTs, biliary type pain, abnormal ductal dilation in POST-CHOLECYSTECTOMY (all three at same time) (likely spasms of sphincter of oddi or stenosis)

40

what is the function of bile acids

bind and absorb fat

41

gold standard for esophageal cancer dx?

EGD with biopsy

42

mc etiology of traveler's diarrhea

e.coli

43

two big non-pharm components of management for IBS include:

dietary/lifestyle change
psychological tx

44

what does carcinoma in situ mean?

cancer that has not spread beyond the layer of cells in which it began (non-invasive)

45

what do carcinoid tumors secrete?

serotonin

recall: carcinoid tumors are neuroendocrine

46

how is shigella transmitted? where is it commonly found?

fecal-oral transmission
daycare, nurseries, long-term care

47

describe the epidemiology of IBD

bimodal distribution: 1st peak 15-30 y/o

industrial countries

caucasians > blacks > hispanics > asians

48

lipase vs amylase in pancreatitis. which is more specific for acute pancreatitis?

lipase (usually >3x ULN)

49

steady, epigastric, periumbilical pain that radiates to the back is often

pancreatitis

50

unconjugated bilirubin comes from what type of cell

RBC

51

risk of IBS increases 6 fold after what infection

infectious gastroenteritis

52

name 4 drugs that can cause constipation

CCBs, diuretics, anti-Ach's, narcotics/opioids

53

tx for Whipples dz

1-2 years of bactrim

54

what are typical lab findings for alcohol hepatitis?

AST/ALT > 2, but neither above 500
AST usually higher than ALT

55

name 4 causes of hepatocellular liver injury

1. autoimmune hepatitis
2. viral hepatitis
3. ischemia
4. drug-induced liver injury (DILI)

56

how do you treat eosinophilic esophagitis?

1. remove foods that incite allergic response
2. inhaled topical corticosteroids

57

define acute liver failure (aka fulminant hepatitis)

rapid liver failure (INR >/= 1.5) AND encephalopathy

58

sxs of sclerosing cholangitis

usually asymptomatic with cholestasis (elevated ALP) or jaundice

59

what are Gray Turner's and cullen's signs? what is it associated with

gray turners = hemorrage from pancreas (on flank)
Cullen's = periumbillical bruising

both show acute pancreatitis

60

what do you do for baby if pregnant mom has HepB?

vaccine for baby and Hep B immunoglobulin (HBIG) right after delivery

61

what is guaiac? what are two diseases can it be seen in (one we talked about more than others)?

blood in stool

diverticulitis
colon cancer

62

what abx can you consider giving a pt with IBS (more effective in IBS-D)?

rifaximin

63

what are the signs of bleeding varices? 1st step to management?

hematemesis, melena, hematochezia

resuscitate!

64

what 3 pre-formed toxins cause food poisoning

1. s. aureus
2. c. perfringens
3. b. cereus

65

ulcers in ZE are most commonly found in the ___

duodenal wall/bulb

66

gold standard for dx GERD?
when is it usually ordered?

24h ambulatory pH monitoring
ordered for: refractory sxs with normal EGD, atypical sxs, failure to respond to pharm therapy, those considered for antireflex surgery

67

treatment for chronic pancreatits

oral pancreatic enzymes

68

what lifestyle modifications can a patient make to help with GERD?

1. wt loss
2. elevation of head of bed at night
3. diet modification: more frequent/smaller meals, avoid fatty & fried foods, peppermint, chocolate, alcohol, carbonated beverages, coffee, tea
4. avoid eating 2-3 hrs of bed time
5. quit smoking

69

fixed risk factors for colon cancer

men
age
black > whites
fam hx of CRC
IBD (crohn's, UC)
personal hx of adenomas, genetic syndromes

70

the 4 classic symptoms of whipple dz are diarrhea, abdominal pain, wt loss, and WHAT?

joint pain (80%, often migratory)

71

clinical features of chronic pancreatitis? (3)

1. abdominal pain
2. steatorrhea (fatty diarrhea (not secreting enzymes that would break down fat))
3. diabetes mellitus

72

non invasive testing for h.pylori? (3)

1. urea breath test
2. serology (looking for Abs)
3. stool antigen (>90% specific)

73

what other dz is seen and screened when someone has celiac

osteopenia (screened with DEXA 1 year post dx)

74

what percentage of bile acid is recycled via portal venous return to hepatocytes?

95% of biliary secretion

75

how are fats broken down

via pancreatic enzyme lipase (with help from bile acids and phospholipids to form micelles)

76

what are the 3 most common causes of acute inflammatory diarrhea?

1. e.coli
2. salmonella
3. camplyobacter

77

what is commonly seen on bx for celiac?

villous atrophy

78

screening recommendations if family hx of CRC in 1st degree relative?

starting 10 years before than youngest affected family member w CRC or at age 40 (whichever is earlier)

every 5 years

79

3 indications for liver transplant?

hep C (#1!)
NASH
EtOH

80

what can cause false negative testing of h.pylori (3)?

PPIs, abx, bismuth

81

what diarrheal etiology is associated with water transmission (esp well water)?

giardia lamblia

82

SIS of diverticulitis

LLQ abdominal pain
fever
N/V
constipation/diarrhea
+/- mass

83

are NSAIDs responsible for more gastric or duodenal ulcers?

15-30% gastric
vs 10% duodenal

84

classic symptom of GERD? when does it occur? what position makes it worse?

substernal burning and/or regurgitation, often after eating, worse when supine

85

what is the most sensitive and specific lab test for ZE? how does it work?

secretin stimulation test

secretin normally reduces gastrin release from G cells, but in ZE pts, gastrin dramatically increases

86

what labs indicate hepatocellular liver injury?

elevated AST and ALT

87

tx for mild/uncomplicated diverticulitis

fluids initially; lower fiber until better, then high fiber
abx: metronidazole + ciprofloxacin

88

what's the clinical presentation of hepatitis A?

1. very high AST/ALT
2. RUQ pain
3. N/V

89

the most common cause of upper GI bleed is ?
how does it usually present?

PUD
melena

90

describe the shape of h.pylori

spiral, flagellated

91

5 year survival rate for stage IV colon cancer?

11%

92

tx for crohn's/UC

1. 5 ASA
2. corticosteroids (acute flares)
3. immune modifying agents
4. anti-TNF agents

93

dx of gastric cancer modality?

EGD with biopsy

94

how do you treat pilonidal disease?

I and D

95

MC presenting sx for PUD

epigastric pain AKA dyspepsia

(often wakes pt up at night 2-3am)

96

3 approaches to colon cancer screening

1. high sensitivity fecal occult blood testing/ FIT test: annually
2. colonoscopy every 10 years from age 50-75
3. flexible sigmoidoscopy: every 5 years

97

what is Barrett's?

esophageal squamous epithelium replaced by precancerous metaplastic columnar cells

98

where does colon cancer most commonly metastasize?

liver then lung

99

define diverticulitis

microperforation of the diverticulum resulting in intra abdominal infection/inflammation

100

the principal inhibitor of HCl production is

somatostatin

101

in addition to rome criteria, other sxs that can support the dx of IBS include: (3)

abnormal stool passage (straining, urgency, etc), passage of mucus, bloating

102

intermittent, stead epigastric, RUQ pain that radiates to right scapula is often

cholecystitis

103

+hepatitis A IgM antibody vs +hepatitis A IgG antibody

which indicates an acute infection?

IgM antibody

104

what is the test for celiac dz?

TTG

105

hep B core Ab indicates what?

active or prior infection (NOT positive with immunization)

106

what is a common clinical manifestation of esophageal cancer?

dysphagia of solid food that progresses into liquid

107

SIS of encephalopathy

confusion
somnolence
asterixis
coma

108

iron deficiency anemia in a male over 50 is _____ until proven otherwise?

CRC

109

what are some lifestyle risk factors for colon cancer?

1. diets in high red meat
2. physical inactivity
3. obesity and T2DM
4. smoking
5. heavy EtOH

110

what's the primary transmission for hep C?

blood (very little sexual); IVDU primarily in US

111

how much fiber should pts eat/day?

20-35 grams

112

sudden, severe epigastric pain that radiates through the entire abdomen is often

perforation

113

what is the main risk factor for zollinger-ellison syndrome?

MEN1 syndrome (20-25%) (parathyroid, pancreas, pituitary tumors)

114

what is charcot's triad

fever, RUQ pain, jaundice

115

both types of esophageal cancers are more common in what gender?
race?

men
squamous= 3:1
adeno= 7:1

116

what are the two categories (and signs) of cirrhosis consequences?

1. portal hypertension (ascites, varices, splenomegaly)
2. synthetic dysfunction (encephalopathy, elevated INR, jaundice)

117

what are the two basic patterns of liver injury

hepatocellular (cells busting open) and cholestatic (congestion)

118

how do you treat infectious esophagitis based on what the endoscoping findings are?

1. linear yellow-white plaques = 1st line: fluconazole
2. ulcers = ganciclovir (CMV), acyclovir (HSV)

119

reynold's pentad suggests what

sepsis

120

imaging of choice for chronic pancreatitis? what does it show?

CT A/P
pancreatic calcifications

121

hepatitis A is transmitted primarily via __

fecal-oral

122

what are the 4 types of esophagitis?

1. reflux
2. eosinophilic
3. infectious (candida, CMV, herpes, HIV)
4. drug induced (NSAIDs, abx (tetra, doxy), bisphosphonates, K+ chloride)

123

gold standard for h.pylori testing?

EGD with biopsy
- + rapid urease test
- histology
- culture

124

gold standard dx method for colon cancer?

colonoscopy

125

three pharm tx for IBS-C?

1. osmotic laxatives (polyethylene glycol)
2. chloride channel activator (lubiprostone)
3. guanylate c agonists (linaclotide)

126

crampy, periumbilical pain that radiates to the back is often

obstruction

127

anti-mitochondrial antibody is positive in what liver biliary dz

primary biliary cholangitis

128

gold standard for SIBO dx

hydrogen breath testing

129

when is FODMAPs used

used for IBS

130

what tumor marker is good to follow for colon cancer but is not necessarily initially diagnosis?

CEA

131

name 4 causes of cholestatic liver injury

1. biliary obstruction (stones, cx)
2. PBC
3. PSC
4. DILI

132

what is the MC cause of acute lower GI bleeding?

diverticulosis

133

which type of esophageal cancer is more common in AAs?

squamous cell

134

MC histological type of gastric carcinoma?

adenocarcinoma

135

what is the key to characterization of liver masses?

IMAGING!

136

if high indirect bilirubin but normal or low direct bilirubin, what type of injury?

ABOVE the liver (i.e., hemolysis issue)

137

what labs indicate cholestatic liver injury

elevated bilirubin and alk phos

138

cholangitis definition

inflammation, infxn of bile duct

139

what is a fistula?

tunnel between anal gland from which the abscess arose, can occur with frequent abscesses, often seen with Crohn's or other underlying problem

140

is ibs more common in men or women?
whites or blacks?

women
whites

141

how do you treat a perianal abscess

I and D (CANNOT give abx as an alternative, will not penetrate the fluid within an abscess)

142

what type of hemorrhoid has a classification system?

internal

143

CD vs UC
which can affect any portion of the GI tract (mouth to anus)?

Crohn's

144

what type of hemorrhoid is usually painful?

external

145

what is the #1 indication for liver transplant?

hep C

146

hep B surface antigen indicates what?

hep B infection

147

what is zollinger-ellison syndrome?

tumor of gastrin-secreting G cells in pancreas, duodenum, ectopic site (gastrinoma)

148

what is carcinoid syndrome?
when is it seen?

flushing, diarrhea

after carcinoid metastasizes

149

what is important in the prevention of hep C?

Education!
avoid sharing needles, birth cohort screening (1945-1965), use barrier protection if multiple sex partners

150

CD vs UC
which is transmural (ie involves the entire thickness of the bowel wall)?

Crohn's

151

what labs are found in celiac dz

endomysial IgA Ab and transglutaminase Ab

152

management of cirrhosis?

1. encephalopathy: lactulose or rifaximin
2. ascites: Na+ restriction (spironolactone, furosemide) +/- paracentesis
3. transplant

153

celiac patients should avoid

wheat, rye, barely

154

what is seen on histology for Whipple's dz?

periodic acid-schiff (PAS)- positive macrophages AND dilated lacteals

155

SIS of malabsorption

diarrhea steatorrhea abdominal bloating
gas wt loss amenorrhea

156

hep C antibody indicates what?

present OR cleared infection

157

wt loss is more commonly associated with what type of ulcer?

GU

158

what type of esophageal cancer is associated with Barrett's/GERD?

adenocarcinoma

159

is heliobacter pylori gram + or -?

gram -

160

what predisposes someone to liver cx?

1. cirrhosis, advanced fibrosis
2. chronic hep b or c
3. biliary dz

161

red flags in IBS

wt loss, new onset in pt >50, nocturnal sxs, family hx of cancer/IBD, anbronal exam, + fecal occult blood test, anemia, fevers, leukocytosis, inflammatory markers

162

what is trousseau's malignancy sign?

migratory phelbitis associated with malignancy
= pancreatic carcinoma

163

how is e.coli is primarly transmitted?

undercooked beef, unpasteurized juices, spinach

164

crampy, steady periumbilical, RLQ pain that radiates to back is often

appendicitis

165

mc benign tumor of the liver?

hemangioma

166

risk factors for cholethiasis

5 F's! female, fat, fertile (preggers), age>forty, family hx

167

what is the frequency of CRC surveillance in patients with UC/CD

start surveillance at 8 years from onset of symptoms, should occur every 1-2 years

168

what can pinworms cause? tx?

pruritus ani, avoid further damage (avoid moisture, soap, etc)

169

what supplies blood to the liver

portal vein

170

what is cholecystitis

gallbladder inflammation

171

how much greater is the risk of esophageal cancer in barrett's?

30-60x > general population

172

what is the funky, board favorite cause of acute pancreatitis

scorpion stings

173

hep C RNA indicates ?

infected

174

the MC cause of functional constipation is

low fiber diets

175

MC cause of diarrhea in pediatrics, what diarrhea-causing virus has a vaccine?

rotavirus

176

herniation/outpouching of upper esophagus on posterior wall is called ?

Zenker diverticulum

177

risk factors associated with squamous cell esophageal cancer?

ETOH
tobacco
achalasia
caustic induced esophageal injury
head and neck cancers

178

risk factors for gastric cancer include the standards (fam hx, tobacco, obesity) and what 3 other main things?

1. h pylori
2. atrophic gastritis/intestinal metaplasia
3. diet: smoked foods, processed meats, red meat, nitrates/nitrites

179

SIS of celiacs

IBS-like bloating/flatulence/ discomfort
Others:fatigue, depression, arthritis, osteopenia/porosis, iron deficiency anemia, dermatits herpetiformis

180

your patient has dysphagia to both solids and liquids. what are you thinking, and what is your next dx step?

achalasia
esophageal manometry (gold standard) = shows increased LES pressure

181

a low FODMAP diet means:

limited fermentable oligo, di, monosaccharides and polyolys

182

LLQ pain is often

diverticulitis

183

constipation can be caused by what endocrine dz

hypothyroidism

184

squamous cell vs adenocarcinoma esophageal cancer in terms of location?

squamous = upper 2/3 of esophagus
adeno = lower 1/3 of esophagus

185

what is reynold's pentad?

charcot's triad + hypotension (shock) and altered mental status

186

sister mary joseph nodes are associated with what? what are they?

gastric carcinoma
umbilical LN

187

hepatocellular carcinoma tx

resection, embolization, radiofrequency TRANSPLANT! = curative

188

MC pancreatic cx histology

adenocarcinoma: ductal MC (>90%)

189

cd vs uc
fecal urgency is seen in what disease?

ulcerative colitis

190

CD vs UC
which affects the colon and starts in the rectum?

ulcerative colitis

191

your pt has an acute GI bleed and presents with melena. what is your next step? if that test is negative, what do you do?     

next step: EGD
If negative: colonoscopy
if negative: bowel studies

192

is amylase/lipase elevated in chronic pancreatitis?

not usually

193

+hepatitis A IgM antibody vs +hepatitis A IgG antibody

which indicates a prior infection OR vaccination?

IgG

194

4 notorious groups of medications that cause esophagitis

NSAIDs
antibiotics
bisphosphonates
potassium chloride

195

what is another name for conjugated bilirubin

direct bilirubin

196

___% of gastric ulcers and __ - ___% of duodenal ulcers are attributed to h.pylori

70% of gastric ulcers
80-95% duodenal ulcers

197

when a patient progresses to cirrhosis, what tends to happen to the labs with regards to total protein, albumin, globulin, ALT, AST

total protein decreased
albumin decreased
globulin increased
ALT/AST not >300
AST > ALT

198

severe, diffuse periumbilical pain that radiates to the entire abdomen is often

infarction

199

#1 cause of pancreatitis

#2?

#1 - stones
#2 - EtOH (years)

200

what two biliary liver diseases can cause elevated bili and ALP?

1. primary sclerosing cholangitis
2. primary biliary cholangitis

201

what is the #1 symptom of pancreatitis?

epigastric pain: RUQ, midepigastric, radiates to back

202

what is hemolytic uremic syndrome? what causes it?

acute renal failure, thrombocytopenia, microangiopathic hemolytic anemia, complicates 10% of cases in those <10 yo

caused by e.coli

203

burning/gnawing paid associated with DU ulcers is typically ____ with

better

204

when should CRC screening start?

age 50 (consider 45 if AA) every 10 years

205

describe familial adenomatous polyposis

1. APC gene mutation
2. autosomal dominant
3. greatest risk factor for colon cancer (colon is removed as ppx)

206

test of choice for diverticulitis

CT scan

207

CD vs UC
which tends to skip areas in the intestine?

Crohn's

208

which of the viral hepatitis(es) are considered chronic infections?

B,C,D

209

medical management for variceal bleeds?

octreotide drip, PPI drip, ABX

210

what are the five alarm symptoms for GI?

1. altered bowel habits
2. bleeding
3. dysphagia
4. early satiety
5. wt loss

211

treatment of thrombosed hemorrhoids

evacuation

212

how do you diagnose and treat schatzki's ring?

dx: barium esophagram (swallow)
tx: endoscopic dilation

213

what is the MC overall cause of gastroenteritis in US adults?

norovirus

214

what do you commonly see on imaging for pancreatic adenocarcinoma?

double duct sign is classic

215

define diverticulosis

acquired herniation or saclike projection of the intestinal mucosa through the muscularis propria

216

what is the main treatment for acute pancreatitis?

supportive: IV fluids is first

217

hep B surface Ab indicates what?

immunity against hep B infection (prior infection OR immunization)

218

name 5 SIS of gastric carcinomas

1. indigestion
2. nausea
3. early satiety
4. anorexia
5. wt loss

219

choledocholithiasis definition

bile duct stones

220

presence of hep C RNA indicates what?

INFECTED

221

if you pt has PUD but is h.pylori neg, what can you give them?

misoprostol (synthetic prostaglandin E1 analog)
(NOT FOR PREGGERS)

222

reynold's and charcot's are associated with what dz

acute cholangitis (biliary tract infection 2ry to obstruction)

223

h. pylori is associated with gastric carcinoma and what other cancer?

MALT (mucosa associated lymphoid tissue) lymphoma

224

what should you do if you suspect gastrinoma (ZE)?

check serum gastrin

225

what disorder commonly involves dysphagia, regurgitation, and halitosis?

Zenker's

226

when should you consider a blood transfusion for GI bleed?

Hgb < 7 OR unstable/rapid bleed

227

what is tenesmus and in what dz is it seen?

feeling of incomplete evacuation of rectum;
ulcerative colitis

228

what 3 proteins does the liver make?

clotting factors
thrombopoietin
albumin

229

what will show up on manometry in a patient with achalasia?

incomplete relaxation of LES (normal relaxation is 90% of basal pressure, achalasia is less than 50%)

230

can you use loperamide or other anti-motility agents in pts with inflammatory diarrhea (shigella, c diff, e coli)?

No

231

Murphy's sign positive in

acute cholecystitis

232

Charcot's triad in what?

cholangitis

233

dark, "tarry" stool is called what? and what can it indicate?

melena,
UGIB (also smells real bad)

234

hematememsis is ________ and it can indicate __________

bloody vomiting, upper GI bleed

235

peeps with cholelithiasis OR s/p cholecystectomy should have what type of diet?

low fat diet
(meals with fat cause GB to contract)

236

encephalopathy should be mainly dx by labs or PE/clinical diagnosis?

PE/clinical!
ammonia levels does NOT correlate

237

does gastric cancer affect men or women more?

men

238

diverticulosis affects what area of the intestine MC

sigmoid colon (95%)

239

the MC presentation of a GI bleed is ? what does it look like?

hematochezia,
bright red blood from rectum (lower GI bleed)

240

what is a unique symptom of diffuse esophageal spasm?

anterior chest pain (similar to angina)

241

Guillain-Barre syndrome is associated with what bacterial etiology of diarrhea?

campylobacter jejuni

242

most important etiologic factors for PUD?

h.pylori
NSAIDs
acid
stress

243

what causes jaundice

too much bilirubin (2.5x normal and up)

244

besides FAP, what other genetic syndrome puts a patient at risk for colon cancer?

Lynch syndrome
(autosomal dominant)

245

conditions commonly associated with IBS? (5)

fibromyalgia
chronic fatigue
functional dyspepsia
depression
anxiety

246

diarrhea is considered persistent after ___ days and chronic after ___ days

14, 30

247

mc location of carcinoid tumors

small intestine (ileum)

248

what is the gastrinoma triangle?

place where 90% of gastrinomas are located: pancreas, duodenum, stomach/liver/bone/LN

249

management of cholecystitis

cholecystectomy

250

abdominal pain and altered bowel habits with no organic cause is

irritable bowel syndrome

251

what specific type of lesion is often seen in the colon of colon cancer?

apple core lesion

252

describe pathology of sclerosing cholangitis

AI disorder of intrahepatic and extrahepatic bile ducts characterized by inflammation and fibrosis

253

what disorder will show cork screw contractions/rosary bead on barium swallow?

diffuse esophageal spasm

254

for abdominal pain and bloating in IBS, what can you consider giving a pt?

amitryptyline or SSRIs/SNRIs

255

tx for severe/complicated diverticulitis

admit
NPO
IV fluids
abx: metronidazole + IV ceftriaxone or IV fluoroquinolone

+/- surgery

256

treatment of mild hemorrhoids

increase the amount of fiber and fluids
sitz bath
hydrocortisone topical tx

257

what's a special feature of c.diff regarding killing the spores?

alcohol foam does NOT kill the spores (must use soap and water)

258

what virus is common in familial outbreaks, nursing homes, cruise ships, college campuses? can it be aerosolized?

norovirus

yes

259

dermatitis herpetiformis is seen w what dz?
where on the body is it usually?

celiac dz
usually on extensor surfaces (knees, lower back, buttock)

260

PEx findings for cirrhosis

ascites, edema, jaundice, spider angiomata

261

what protozoa are bad for immunocompromised people?

"SPOR"

cyclospora
isospora
cryptosporidium
microsporidia

262

4 etiologies of infectious esophagitis

candida, cmv, hsv, hiv

263

what tumor marker do you follow for pancreatic adenocarcinoma?

CA 19-9

264

what is Courvoisier's sign?

palpable, nontender, distended gallbladder
= pancreatic carcinoma

265

SIS of acute liver failure

lethargic, + asterixis, jaundiced, + liver edge palpable

266

your pt has glossitis and stomatitis on PEx. what might this suggest?

failure to absorb vitamins

267

what type of diet s/p bariatric surgery?

full liquid/pureed diet for 2-3 weeks, then soft foods, then regular food

lifelong: B12, calcium/vit D, multivitamin supplements

268

when is alternate route of nutrition needed? (3)

1. GI/surgical illness more than 3-5 days
2. intubated patients on vent more than 3 days
3. stroke/dysphagia/end of life

269

Grey Turner's is found on PEx for what? what is it?

Pancreatitis (acute)

bruising around flank/hip due to retroperitoneal hemorrhage

270

diarrhea that lasts less than 4 weeks is considered ____ and _______

acute
infectious

271

no change in diarrhea when fasting indicates what type of diarrhea (osmotic, secretory, increased motility, inflammatory)

secretory (excess input of electrolytes w H2O following)

272

malabsorption of stuff can lead to what type of diarrhea?

osmotic (increased presence of poorly absorbed lumnial osmols)

273

anxiety, hyperthyroid, IBS, viral gastroenteritis is often responsible for what type of diarrhea

increased motility

274

fever, abdominal pain, tenesmus, bloody poo and fecal WBCs is associated with

inflammatory diarrhea

275

give 3 examples of preformed toxins that lead to food poisoning

s. aureus
c. perfringens
b. cereus

276

define diarrhea

>3 BMs per day
> 200 gms/ day
loose or liquid consistency

277

where is vibrio cholera found? what is the presentation? what is a major concern?

contaminated H20
rice- water stools
severe dehydration
noninflammatory

278

what is often found on cruise ships and college campuses? is it non-inflammatory or inflammatory?

norovirus, noninflammatory

279

the MC cause of diarrhea in children? is it noninflammatory or inflammatory?

rotavirus, noninflammatory

280

this parasite is found in contaminated streams and can cause chronic infection in immunocompromised

giardia, non inflammatory

281

contaminated poultry, eggs, dairy bug

salmonella

282

tx for camplobacter

azithromycin

283

osteomylitis, endocarditis, arthritis are symptoms in 10% of peeps with this bug

salmonella

284

important sanitary point about c diff

soap and water ! (alcohol does not kill)

285

tx for c diff

metronidazole

286

do you use anti-motility (loperamide) w inflammatory diarrhea?

NO (can be toxic)

287

ppx therapy for travelers diarrhea

bismuth salicylate

288

first line for sever infectious diarrhea (EXCEPT CAMPLOBACTER)

FQs (cipro)