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CPD Upper GI Wk 5 Quiz > CPD II Quiz UGI II and Lower GI I > Flashcards

CPD II Quiz UGI II and Lower GI I Flashcards

1
Q

Pathology of Cirrhosis

A

extensive fibrosis that disrupts normal liver architecture

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2
Q

PE Cirrhosis

A

Nail clubbing, small liver

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3
Q

What are the effects of liver disease on drug metabolism?

A

Liver dz can alter intestinal absorption, plasma protein binding, liver blood flow, etc.
- This increases level of bioavailable drug = toxic effects.

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4
Q

What are the two types of liver injury due to Drug-induced liver injury (DILI)?

A
  • hepatocellular (serious): from acetomenophine
    - malaise, RUQ pain
  • cholestatic (less serious): from amoxicillin
    - pruritis and jaundice
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5
Q

Fibrosis

A

excessive connective tissue accumulates in the liver in response to chronic, repeated liver cell injury (scar tissue)

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6
Q

Sx fibrosis

A

no sx, but secondary sx can develop

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7
Q

Cirrhosis

A

late stage of hepatic fibrosis that is widespread distortion of hepatic architecture

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8
Q

sx cirrhosis

A 
non specific (anorexia, wt loss, fatigue)
late sx: portal HTN
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9
Q

Lab workup cirrhosis

A 
LFT normal
albumin and bilirubin
PT
CBC
viral tests for causes
*liver biopsy
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10
Q

PE for cirrhosis

A
  • liver edge bumpy

- pallor, jaundice, petechiae, purpura, ascites, splenomegaly, nail clubbing

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11
Q

Primary biliary cirrhosis

A

autoimmune

  • destruction of bile ducts
  • leads to cholestasis, cirrhosis, liver failure,
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12
Q

Sx primary biliary cirrhosis

A

insidious fatigue, pruritis, dry mouth, RUQ pain, jaundice, Middle aged women.

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13
Q

PE primary biliary cirrhosis

A

enlarged, firm, non-tender liver

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14
Q

work-up

A

elev GGT and alk phos

biopsy

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15
Q

causes of vascular liver disorders

A

ischemia: reduced blood flow, reduced O2 delivery, inc metabolic activity
insufficient venous drainage

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16
Q

Hepatic ischemic hepatitis

A
  • impaired hepatic profusion due to heart failure or acute hypotension
  • hyoxemia: resp failure or CO2 toxicity
  • increased metabolic demand (sepsis)
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17
Q

SX ischemic hepatitis

A

nausea, vomitting, tender hepatomegaly

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18
Q

lab for schemi hepatitis

A

high aminotransferase
inc in bilirubin
LDH increases (septic)
*US, MRI

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19
Q

ischemic cholangiopathy

A

focal damage to biliary tree due to disrupted flow from the hepatic artery

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20
Q

causes of cholangiopathy

A

vascular injury during procedures that result in bile duct injury

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21
Q

what does bile duct injury cause?

A

cholestasis, chalngitis, biliary strictures

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22
Q

Sx cholangiopathy

A

pruritis, pale stool

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23
Q

congestive hepatopathy

A

diffuse venous congestion in the liver that results from RCHF

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24
Q

SX congestive hepatopathy

A

asx, RUQ discomfort

- if severe cong = jaundice

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25
Q

PE congestive hepatopathy

A

acites, hepatomegaly

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26
Q

causes of hepatic artery occlusion

A

thrombosis, emboli, iatrogenic causes, vasculitis, structural abn, eclampsia, cocaine, sickle cell crisis

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27
Q

sx hepatic artery occlusion

A

infarction can be asx or cause RUQ pain, fever, nausea, vomitting, jaundice

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28
Q

Bud chiari syndrome

A

obstruction of hepatic venous outflow from small hepatic veins inside liver to inferior vena cava and R atrium

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29
Q

Causes bud chiari syndrome

A

hypercoagulable states

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30
Q

sx bud chiari syndrome

- acute and chronic obstruction sx

A

none to fulminant liver failure

  • acute obstruction: fatigue, RUQ pain, nausea, vomitting, mild jaundice
  • chronic: asx, or fatigue, abdominal pain, hepatomegaly, edema
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31
Q

prognosis bud chiari syndrome

A

die within 3 years of liver failure if untreated

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32
Q

cause of veno-occlusive disease

A

endothelial injury leading to non-thrombotic occlusion of terminal hepatic venues and hepatic sinusoids
- irradiation, graft, hepatotoxins

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33
Q

ssx veno-occlusive disease

A

sudden jaundice

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34
Q

PE veno-occlusive disease

A

ascites, tender, smooth, hepatomegaly

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35
Q

Portal vein disorders

A

cause portal HTN

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36
Q

causes of portal vein thrombosis

A

surger, hypercoagulability, cancer, cirrhosis, trauma

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37
Q

Peliosis hepatatits

A

multiple blood filled cystic spaces develop randomly in the liver

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38
Q

causes peliosis hepatitis

A

damage to sinusoidal lining cells from use of hormones

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39
Q

sx peliossis hepatitis

A

asx, but if cysts rupture, hemorrhage and death can result

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40
Q

causes Portal HTN

A

cirrhosis, schistosomiasis, hepatic vascular abnormalities

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41
Q

SX Portal HTN

A

asx

sx arise from complications

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42
Q

PE Portal HTN

A 
low systolic BP
splenomegaly
ascites, peripheral edema
dilated abdominal wall veins, caput madusae
skin jaundice, spider angioma
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43
Q

lab?

A

US and CT = dilated intraabdominal collateral arteries

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44
Q

Portal Systemic encephalopathy

A

neuropsychiatric syndrome

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45
Q

causes of portal systemic encephalopathy

A

fulminant hepatitis caused by viruses, drug, or toxins
cirrhosis, portal HTN
liver disease
cerebral depressants (alcohol, sedatives)

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46
Q

Primary liver cancer

A

hepatocellular carcinoma

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47
Q

cause hepatocellular carcinoma

A

cirrhosis

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48
Q

risk factors for hepatocellular carcinoma

A

HBV, HCV, hemochromatosis, alcoholic cirrhosis

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49
Q

SSX hepatocellular carcinoma

A

RUQ pain, weight loss, RUQ mass

50
Q

workup hepatocellular carcinoma

A

alpha-fetoprotein (AFP) high

CT, US, MRI

51
Q

Metastatic liver cancer

A

more common than primary liver cancer

- GI, breast, lung, pancreas

52
Q

Hepatic Granulomas

A

localized collections of chronic inflammatory cells with epithelia cells and giant multinucleate cells

53
Q

causes hepatic granulomas

A

drugs, infections (TB and schistosomiasis)

54
Q

SSX hepatic granulomas

A

asx

55
Q

Risk factors for cholelithiasis

A

5Fs: female, fat, forty, fertile, family hx

SAD diet, American indian ethnicity

56
Q

SX cholelithiasis

A

asx, RUQ pain that radiates

57
Q

cholecystitis

A

inflammation of gallbladder

58
Q

acute cholecystitis

A

develops in hours becomes a gallstone that obstructs the cystic duct

59
Q

SSX acute cholecystitis

A

pain like biliary colic but lasts longer

vomitting

60
Q

PE acute cholecystitis

A

R subcostal tenderness
+ Murphy sign
- courvosier sign
fever

61
Q

Chronic cholecystitis

A

due to stones

porcelain gallbladder if extensive calcification due to fibrosis

62
Q

SX chronic cholecystitis

A

recurrent biliary colic

63
Q

PE chronic cholecystitis

A

upper abdominal tenderness

afebrile

64
Q

acalculous biliary pain

A

biliary colic without stones from structural or functional disorders

65
Q

causes acalculous biliary pain

A

microscopic stones

abnormal GB emptying

66
Q

causes postcholecystectomy syndrome (PCS)

A

alterations in bile flow due to loss of function of gallbladder as a reservoir

67
Q

Sx postcholecystectomy syndrome

A

dyspepsia, persistent abdominal pain

68
Q

workup for PCS

A

biliary manometry

69
Q

Choledocholithiasis

A

stones in the bile ducts causing biliary colic, biliary obstruction, cholangitis

70
Q

Cholangitis

A

Acute is EMERGENCY

bile duct obstruction allows bacteria to ascend from duodenum

71
Q

SX acute cholangitis

A

Charcot’s Triad:
abdominal pain
jaundice
fever or chills

72
Q

PE cholangitis

A

RUQ tenderness
liver tender and enlarged
confusion and hypotension = 50% mortality rate

73
Q

Recurrent Pyogenic Cholangitis

A

inrahepatic brown stone formation leading to repeating cycles of obstruction, infection, and inflammation.
SE Asia

74
Q

cause of recurrent pyogenic cholangitis

A

undernutrition and parasitic infxn

75
Q

What would you expect if you saw biliary colic and jaundice?

What would you expect if you saw these symptoms plus fever and leukocytosis?

A

choledocholithiasis and cholangitis

cholangitis

76
Q

What would you expect to see on labs suggesting stone/extrahepatic obstruction?

A

Elev bilirubin, alk phos, ALT, GGT

77
Q

What would you expect to see on labs due to acute cholangitis

A

CBC leukocytosis

LFT: AST and ALT hepatic necrosis

78
Q

primary sclerosing Cholangitis SX

A

progressive fatigue and pruritis, jaundice later, steatorrhea, gallstones 75% of pt, cirrhosis, hepatosplenomegaly

79
Q

Cholangiocarcinoma

A

rare but malignant tumor of extra hepatic bile duct

80
Q

Risk factors for cholangiocarcinoma

A

primary sclerosing cholangitis
older age
infestation with liver flukes

81
Q

sx cholangiocarcinoma

A 
pruritis
painless obstructive jaundice
abdominal pain
anorexia
weight loss
82
Q

PE chalangiocarcinoma

A

non-tender palpable mass (courvoiser’s sign)

hepatomegaly

83
Q

risks gallbladder carcinoma

A 
uncommon
native american ethnicity
large gallstones
GB calcification due to chronic cholecystitis
most have gallstones
84
Q

what are the extra PE steps for lower GI issues?

A 
peritonitis: Blumberg sign
Appendicitis: signs
Ascites: fluid wave and shifting dullness
Cholecystitis: Murphys sign
Kidney inflmm: CVA tenderness
DRE
Gyn and male genitalia exam
85
Q

Labs for lower GI

A 
CBC
CMP
amylase/lipase
stool culture
CDSA 
GI health panel
abdominal X-rays
US
endoscopy/sigmoidoscopy/colonoscopy
86
Q

List 3 causes of RUQ pain

A

Hepatitis
cholecystitis
Budd Chiari syndrom

87
Q

List 3 causes of Epigastric pain

A

GERD
Gastritis
PUD
Pancreatitis

88
Q

List 3 causes of LUQ pain

A

Spleen infarct
splenic rupture
gastritis

89
Q

List 3 causes of right or left flank pain

A

kidney infl
pyelonephritis
polyscystic kidney disease

90
Q

List 3 causes of periumbilical pain

A

Early appendicitis
gastroenteritis
bowel obstruction

91
Q

List 3 causes of RLQ pain

A

appendicitis
IBD
Ovarian cyst
inguinal hernia

92
Q

List 3 causes of LLQ pain

A

Diverticulitis
IBD
IBS
ovarian cyst

93
Q

osmotic diarrhea

A

too much water drawn into bowels and increased amount of poorly absorbable solutes

94
Q

causes of osmotic diarrhea

A

maldigestion

ions (mag sulfate, mg, vit C, sugar alcohols)

95
Q

causes of secretory diarrhea

A 
enterotoxins (cholera, E.coli, staph)
horomones (serotonin)
gastric hypersecretion (ZE)
laxatives
bile salts
96
Q

causes of exudative diarrhea

A

idiopathic
crohns
ischemic
infections - shigela, salmonella

97
Q

causes of motility diarrhea

A

hyperthyroidism

DM

98
Q

diarrhea red flags

A 
blood
pus
fever
signs of dehydration
chronicity
unintended wt loss
99
Q

red flags for constipation

A

abdominal distention
vomitting
blood in stool
weight loss

100
Q

cause of acute constipation

A

obstruction
adynamic ileus
medications

101
Q

cause of chronic constipation

A

carcinoma
hypothyroid
CNS disorders
IBS

102
Q

red flags for gas

A

weight loss, blood in stool

103
Q

Dyschezia

A

difficulty evacuating
urge but can’t go
due to disco ordination of rectal muscles and sphincter

104
Q

O and P test

A

done to find protozoa, worms, eggs, parasites

105
Q

History for acute abdomen

A 
LMNOPQRST
concomitants
drug hx
PMHx
previous surgery
106
Q

Causes of inflammation

A 
appendicitis
cholecystitis
pancreatitis
diverticulitis
abscess
107
Q

Causes of ischemia

A

Ischemic colitis

108
Q

CBC findings for appendicitis

A

WBC count > 10,000 with left shift

109
Q

DDX appendicitis

A

females: PID
males: epidiymitis, testicular torsion
acute gastroenteritis

110
Q

Acute Mesenteric Ischemia

A

EMERGENCY

decrease in mesenteric blood flow, leading to bowel wall ischemia, inflammation, and infarction.

111
Q

causes of acute mesenteric ischemia

A
  1. diminished bowel perfusion due to low cardiac output often seen with CHF
  2. occlusive disease of vascular supply if bowel due to thrombosis or embolism
112
Q

risk factors for acute mesenteric ischemia

A

CAD, a fib, hypercoagulability, portal HTN

113
Q

SX acute mesenteric ischemia

A

severe and pain with minimal PE findings
sudden onset suggests embolism
gradual suggests thrombosis
later: guarding, absent bowel sounds

114
Q

Ischemic colitis

A

episodic transient reduction of blood flow to bowel

115
Q

hernia of abdominal wall

A

Emergency if strangulated

116
Q

Intestinal obstruction

A

EMERGENCY

complete or partial blockage of small bowel or colon

117
Q

causes of intestinal obstruction

A 
adhesions
hernia
tumor
diverticulitis
foreign body
118
Q

sx intestinal obstruction

A

sudden onset periumbilical or epigastric cramping, vommiting,

119
Q

ileus

A

temporary arrest of intestinal peristalsis

120
Q

causes of ileus

A

post-surgical
appendicitis
diverticulitis
perforation

121
Q

sx of ileus

A

distention
vomiting
abdominal discomfort
colicky pain

CPD Upper GI Wk 5 Quiz (2 decks)

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