Exam 1: GI Flashcards
(126 cards)
1
Q
A hiatal hernia is diagnosed using
A
Barium Swallow
2
Q
50-94% of patients with Gerd have a
A
Type 1 hiatal hernia
3
Q
In order to diagnose GERD, you would do a
A
EGD (Esophagogstrododenoscopy)
4
Q
A surgical option for the treatment of GERD that also repairs hiatal hernias at the same time is called
A
Nissen Fundoplication
5
Q
Famotidine (H2 receptor antagonist) dose for GERD tx is
A
10 mg twice daily
6
Q
Cimetidine (H2 receptor antagonist) dose for GERD tx is
A
200 mg twice daily
7
Q
Treatment of Mild Gerd includes
A
- lifestyle changes
- H2 receptor antagonists “-tidine”
- Antacids
8
Q
Treatment of severe Gerd includes
A
- Lifestyle changes
- Proton pump inhibitors (PPIs “-prazole”)
9
Q
Omeprazole (PPI) dose for GERD tx is
A
10 mg daily
10
Q
Lansoprazole (PPI) dose for GERD tx is
A
15 mg daily
11
Q
Pantoprazole (PPI) dose for GERD tx is
A
20 mg daily
12
Q
Most common esophageal disorder is
A
Achalasia
13
Q
Diagnosis of achalasia includes
A
Barium swallow (displaying a “birds beak”)
14
Q
treatment options for achalasia includes
A
- Pneumatic balloon dilation (~50% effective)
- Endoscopic botulinum toxin (wears off)
- Esophageal myotomy (Heller myotomy)
15
Q
A false diverticulum / outpouching of mucosa is known as
A
Zenker’s diverticulum
16
Q
Zenker’s diverticulum is diagnosed with
A
Fluoroscopy with barium
17
Q
Treatment of a Zenker’s diverticulum that is < 1 cm is
A
conservative management
18
Q
Treatment of a Zenker’s diverticulum that is > 1 cm is
A
Excision of the diverticulum
19
Q
Esophageal spasm is diagnosed via
A
manometry
20
Q
Mallory Weiss syndrome is diagnosed via
A
EGD (Esophagogstrododenoscopy); usually resolves spontaneously
21
Q
Esophageal varices are diagnosed via
A
EGD (Esophagogstrododenoscopy)
22
Q
The best way to diagnose an esophageal perforation is
A
chest CT most sensitive
23
Q
How treat esophageal perforation
A
NG tube placement + antibiotics with emergent surgical repair
24
Q
Diagnosis / Treatment of foreign bodies include
A
Endoscopy (EGD) both dx and therapeutic
25
what type of hernia is when the GE junction rises above the diaphragm but the fundus remains below the GE junction?
Type I (sliding)
26
Gerd and Barret's esophagus are both associated with which type of esophageal cancer?
Adenocarcinoma
27
MC causes of gastritis include
H-pylori infection and chronic NSAID use
28
To define the anatomical location of gastritis you would do a
Endoscopy
29
To determine the etiology of gastritis you would do a
biopsy
30
If H.pylori gastritis was suspected you could dx it with
Urea C13 or C14 breath testing OR H.pylori stool antigen
31
Treatment of gastritis includes
PPI, H2 blockers, and +/- sucralfate
32
Dx of Peptic ulcer disease includes
EGD and Biopsy (can also test for H-pylori)
33
Tx of uncomplicated PUD is
PPI (like omeprazole) x 2 weeks with antibiotics for H. pylori
34
Tx of complicated PUD is
PPI x 4 weeks with antibiotics for H. pylori
35
Antibiotic tx for H.pylori is
Clarithromycin (500 mg) and amoxicillin (1g) BID regimen x 14 days
36
Esomeprazole dose for tx of PUD is
20-40 mg
37
Lansoprazole dose for tx of PUD is
30 mg
38
Omeprazole dose for tx of PUD is
20-40 mg
39
what type of gastric ulcer dz has the lowest risk of cancer?
Type II
40
what type of gastric ulcer dz is the most common?
Type I
41
what type of gastric ulcer dz is secondary to chronic NSAID use?
Type III
42
If a gastric ulcer fails to heal after adequate medical therapy then it is highly suggested of an
underlying malignancny
43
Indications for the surgical treatment of gastric ulcers is
bleeding, perforation, obstruction, intractability, and high suspicion of malignancy
44
All surgical procedures of gastric ulcers involves
excision of the ulcer (unlike duodenal ulcer)
45
Surgical options to repair gastrointestinal continuity after an ulcer includes one of three options
- Billroth I
- Billroth II
- Roux-en-Y
46
Operative intervention such as Truncal vagotomy with pyloroplasty or antrectomy is treatment for
Complicated PUD (manifestations of complicated gastric AND duodenal ulcers)
47
MC cause of UGI bleeds is
Bleeding PUD
48
Bleeding PUD is confirmed with
EGD / endoscopy
49
Perforated PUD is diagnosed via
Upright CXR that may show free intraperitoneal air (pneumoperitoneum)
50
Inability to tolerate oral intake / projectile vomiting shortly after eating; weight loss
Also a possible complication of Bilroth I is suggestive of
Gastric outlet obstruction
51
Intractable PUD is sx of persistent dz after adequate non-operative therapy which should alert to possible rare causes of ulcer dz such as
- Zollinger-Ellison syndrome
52
Zollinger-Ellison syndrome is
A gastrin secreting tumor where 2/3s are malignant
53
Zollinger-Ellison syndrome is dx via
EGD/Endoscopy plus an elevated serum gastrin
54
First line tx for Zollinger-Ellison syndrome is
PPIs
55
Crohn's disease is dx via
*Colonoscopy (plus EGD)* OR plus MR/CT enterography
56
Dx test of choice for ulcerative colitis is
colonoscopy
57
Barium enema dx test for ulcerative colitis shows
Loss of haustrae and pseudopolyps
58
Ulcerative colitis has a HIGHER RISK for ____________ than Crohn's
colon cancer
59
what is the most common benign liver lesion?
Cavernous Hemangioma
60
what type of benign liver lesions are most typically found in middle aged women 20-50 yrs?
Hepatic adenoma
61
A hepatic adenoma has a higher risk of hepatocellular cancer in
- larger lesions >5cm
- and in men
62
What type of benign hepatic lesions have a classic central, stellate star on CT w/ contrast or a spoke wheel pattern on arteriography?
Focal Nodular Hyperplasia (FNH)
63
Initial diagnostic imaging for hepatic cysts is
Ultrasound
64
A hepatic abscess is treated with
- aspiration / drain placement
- Abx for bacterial abscess
- *Flagyl for amebic abscess
65
Tx of spontaneous bacterial peritonitis of the liver (infection of ascitic fluid) is
Cefotaxime or Ceftriaxone
66
Triple therapy tx including Albumin/octreotide/midodrine are used to treat
Hepatorenal syndrome
67
Hepatic Hydrothorax is usually on what side?
right side
68
What condition is a pleural effusion with cirrhosis and NO evidence of underlying cardio/pulm disease?
Hepatic hydrothorax
69
Portopulmonary HTN is dx via
Right heart catheterization
70
Wilson's disease is a disease of
Copper metabolism
71
Kayser-Fleischer rings in the eyes are associated with what disease?
Wilson's disease
72
If Wilson's disease is caught early, it can be treated with
D- penicillamine
73
Hemochromatosis is a disease of
excessive iron deposition
74
Hemochromatosis treatment includes
Serial phlebotomy
75
What is the largest risk factor (90%) for Hepatocellular carcinoma?
Cirrhosis
76
In patients with liver cirrhosis, all liver lesions are ___________ until proven otherwise
Hepatocellular carcinoma
77
A type of cholangiocarcinoma (gallbladder cancer) that occurs at the right and left hepatic ducts is known as a
Klatskin tumor
78
90% of pancreatic neoplasms are
ductal adenocarcinoma
79
The biggest risk factor for pancreatic cancer is
Cigarette smoking!
80
Alpha feta-protein can be monitored in what type of cancer
Hepatocellular Carcinoma
81
CA-19-9 can be monitored in what type of cancer?
Pancreatic cancer
82
what is Whipple's triad consist of
1. fasting hypoglycemia
2. with associated sx
3. And immediate relief of sx after the administration of IV glucose
83
What is Whipple's triad suggestive of?
An Insulinoma (tumor in the pancreas)
84
In a patient with PUD and diarrhea that has NOT responded to tx you may suspect
Zollinger-Ellison syndrome
85
Watery diarrhea and hypokalemia (esp. in kids < 10 yrs) is likely a
VIPoma (aka pancreatic cholera)
86
VIPoma is dx via
- fasting plasma VIP levels
- measure diarrhea volume
87
Tx of VIPoma is
- Octreotide IM
- Surgical resection or
- Chemo (refractory cases)
88
Most common type of stomach cancer that originates at the glandular tissue is
Gastric adenocarcinoma
89
What is the #1 risk factor of stomach cancer?
H.pylori infection!!!
90
an early symptom of stomach cancer is
dyspepsia
91
first line dx of stomach cancer is
EGD with biopsy (then other stuff)
92
Most common benign tumor of the small bowel is
Leiomyomas / Benign GIST
93
2nd most common benign tumor of the small bowel that causes bleeding and obstruction is
hemangiomas
94
what benign tumor of the small bowel has the potential to become adenocarcinoma?
Adenomas (should be resected if found)
95
50% of all small intestinal malignancies is
adenocarcinoma
96
Most common location of intestinal adenocarcinoma is in the
duodenum
97
Small bowel adenocarcinoma is treated with
wide resection of involved bowel
98
Small bowel adenocarcinoma tx if +lymph nodes
wide resection plus adjunctive chemotherapy
99
Carcinoid tumor is dx with
Urinary 5-HIAA
100
episodic cutaneous flushing, bronchospasm, wheezing, and cramping/diarrhea are all signs of
Carcinoid syndrome
101
Carcinoid tumor is more likely to metastasize based on
The size of the tumor:
2% if <1cm
50% if 1-2cm
90% if >2 cm
102
leiomyosarcoma (aka malignant GIST) metastasize to the
lung and liver
103
colon cancer is most commonly caused by
Adenocarcinoma
104
High risk factors for colon cancer include
-Familial adenomatous polyposis
- UC or Crohn's over 10 yrs
105
Screening a high pts for colon cancer is
fist colonoscopy before the age of 45 (usually 40) or if symptomatic; colonoscopy every 3-5 yrs
106
typical screening for colon cancer
- Colonoscopy at age 45-75
- Polys = remove and repeat ever 5yrs
- no polys = everyday 10 yrs
107
If a pt elects to do a flexible sigmoidoscopy how often is one done?
- every 5 yrs
- or every 10 with fecal occult blood test
108
what staging system is used to stage colon cancer?
Duke's classification
109
Duke's classification
A = confined to the mucosa (>90% survival)
B1 = invades the muscularis propria (75%)
B2 = extends through the muscularis (60%)
C = same level as duke's B but with positive notes (20-50%)
D = metastatic (<5%)
110
what is a significant risk factor of anal cancer?
HPV
111
sx of anal cancer include
rectal bleeding, discomfort, a mass, and pruritus (can be confused with hemorrhoids)
112
most anal cancers in the US are
squamous cell carcinomas
113
anal tumors are dx with
Colonoscopy with biopsy
114
what does follow up of anal cancer involve?
- Every three months (for first 2 yrs): Hx/PE, and CEA
- Every 4-6 months for (2-5 yrs): Hx/PE, CEA
- Colonoscopy every 1 yr after dx. If abnormal repeat the next year otherwise repeat in 2-3 yrs
115
Biliary Dyskinesia is dx with
HIDA scan
116
Tx of choledocholithiasis is
ERCP with removal and sphincterotomy
117
In a hemodynamically stable patient with splenic trauma, the treatment of choice is...
Non-operative management
118
In a unstable patient with splenic trauma, the treatment is
Laparotomy
119
Best initial test if suspecting acute pancreatitis
amylase and lipase
120
In cases of acute pancreatitis which of the following is associated with the worst prognosis?
A. Elevated amylase
B. Elevated lipase
C. Intensity of the pain
D. Low calcium
E. Rising C-reactive protein
D. Low calcium
121
Dx test of choice to tx acute appendicitis is
CT with contrast
122
Carcinoid lesions of the appendix less than 2cm and NOT at the base of appendix is treated with
Appendectomy
123
Carcinoid lesions of the appendix GREATER than 2cm OR those at the base are treated with
Right hemicolectomy
124
A postitive IgA anti-tissue transglutaminase antibody (tTG-IgA) indicates what disease?
Celiac Disease
125
Initial diagnostic test of choice to dx chronic mesenteric ischemia is
CT with contrast
126
Gold standard dx and tx of chronic mesenteric ischemia is
angiography
