Gastro Flashcards
1
Q
Secreted by parietal cells
A
Hydrochloric acid
2
Q
Digests proteins secreted by chief cells
A
Pepsin
3
Q
Stimulates stomach acid secretion and motility.
secreted by G cells
A
Gastrin
4
Q
directly stimulates parietal cells to secrete Hydrochloric acid
A
Acetylcholine
5
Q
Inhibits parietal cell gastric secretion and buffers acid chime leaving the stomach
A
Secretin
6
Q
Stimulates bile release and amylase/lipase for fat and protein breakdown
A
Cholecystokinin
7
Q
Suppresses the release of GI hormones: inhibits secretion of gastrin
A
Somatostatin
8
Q
Produced by pancreatic Alpha cells
Beta cells
A
Glucagon
Insulin
9
Q
Water soluble contrast used in upper GI study when perforation is suspected
A
Gastrografin (Replacing Barium)
10
Q
Caused MC by GERD: common in immunocompromised with candida, CMV or HSV. Radiation therapy
Painful swallowing. RF- Prego, ETOH, SMoke, Chocolate, spicy food, Meds. Dx- Multiple corrugated rings
A
Esophagitis
11
Q
Linear white plaques esophagitis and Tx?
A
Candida
Tx- PO Fluconazole
12
Q
small deep ulcers esophagitis and Tx?
A
HSV
Tx- Acyclovir
13
Q
Large superficial shallow ulcers esophagitis?
A
CMV
Tx- Ganciclovir
14
Q
Pill induced esophagitis MCC
A
NSAIDS, Bisphosphonates, Potassium chloride, Iron pills, BBs, CCBs.
15
Q
Incompetent or transient LES relaxation MCC. Heartburn is hallmark. cough at night, dysphagia, water brash.
Dx- and Tx
A
GERD
DX- 24 hr pH GS: Endscopy 1st.
Tx- Lifestyle mods, H2 Antagonist, PPI, Fundoplication
16
Q
GERD: _____ cells replaced by _______ cells can lead to what kind of carcinoma?
A
Squamous to Columnar cells (Barret’s Esophagus)
Adenocarcinoma
17
Q
Increased LES tone 2T loss of Aurbach’s Plexus. dysphagia to both solids and liquids. –> weightloss.
Dx- GS is ______ and esophagram shows (CXR)
Tx-?
A
Achalasia
Dx- GS is Manometry: Bird’s Beak
Tx- Botulinum Inj. 6-12 mos, nitrates, CCBs, Sx
18
Q
Excessive contraction during peristalsis. Normal Esophagram and EGD
Dx-
Tx-
A
Nutcracker Esophagus
Dx- Manometry
Tx- CCBs, Nitrates, Botox, sildenafil
19
Q
Dysphagia, regurgitation of undigested food, choking sensation, halitosis.
Dx-
Tx-
A
Zenker’s Dicerticulum
Dx- Barium Esophagram
Tx- Diverticulectomy Sx
20
Q
Full thickness rupture of the distal esophagus. 2T repeated forceful vomiting.
Retrosternal pain worse with deep breath/swallowing.
Dx- and Tx ?
A
Boerhave Syndrome
Dx- Ct scan/CXR
Tx- stable= Iv, Fluids, NPO, Abx, H2-a Severe= Sx
21
Q
UGI bleeding from longitudinal mucosal laceration @ GE junction. 2T persistent retching. vomiting etoh/bulimia
Hematemesis after ETOH binge. Hydrophobia.
DX- and Tx?
A
Mallory-Weis tear
Dx- Upper endoscopy TOC
Tx- Supportive (Severe- Epi inj., Ligation, balloon)
22
Q
lower esophageal constrictions/webs @ squamo-columnar jx. MC associated with Hiatal hernias
A
SCHATZKI Ring (Esophageal Web/Ring)
23
Q
Caused by portal vein hypertension. MC RF is _______.
Upper GI bleed, hematemesis, melena, hematochezia
TX- 1. TOC? 2. Pharmaco DOC 3. Prevention
A
Esophageal Varices (Cirrhosis MC RF)
Tx- 1. Endoscopic ligation: 2. Octreotide 3. BBs (Prop-Nad)
24
Q
MC type of hiatal Hernia
A
Sliding Type 95% (GE Junction + stomach slide)
(Rolling- (paraesophageal) Fundus of stomach protrudes through diaphragm.
25
MC Esophageal Neoplasm @ ____ 1/3?
Usually complication of GERD--> Barret's DX-?
Adenocarcinoma: Upper 1/3
EGD with Bx
26
MCC of gastritis: 2nd MCC and 3rd?
Epigastric pain, NV, anorexia, hematemesis, melena.
DX- ?
```
#1 H. Pylori
#2 NSAIDS
#3 Acute stress
```
Dx- Endoscopy GS
27
H. Pylori positive Triple therapy
(CAP)
Clarithromycin
Amoxicillin
PPI
28
Burning, gnawing, hunger like epigastric pain, worse at night: worse/ food provoked 1-2 hours after meal
Gastric Ulcer Peptic Ulcer disease
29
Burning, gnawing, hunger like epigastric pain, worse at night: relieved with food, antacids.
Duodenal Ulcer Peptic Ulcer disease
30
H. Pylori Testing gold standard?
MC used? and which confirms eradication
Endoscopy with Biopsy
MC used= Urea Breath test Eradication= Stool Ag
31
Sudden onset severe diffuse abdominal pain. Rigid abdomen with rebound tenderness think______
MC?
Duodenal Ulcer perforation
32
Quadruple H. Pylori therapy?
BTM-P
| Bismuth Subsalicylate, Tetracycline, Metronidazole, PPI
33
Medication forms viscous adhesive coat that protects and promotes healing of mucosa
Sucralfate
34
Medication used in Esophageal varices that is a somatostatin analog--> vasoconstriction of portal vein
Decreases Gastrin/ Reduces bleeding
Octreotide
35
Gastrin secreting neuroendocrine tumors--> gastric acid hypersecretion--> PUD Kissing Ulcers" both sides lumen
Dx and Tx
Zollinger-Ellison Syndrome
Dx- Increased Fasting Gastrin Levels + pH<2
Tx- Sx
36
MC Gastric carcinoma WW?
Most important RF is _____
Adenocarcinoma
H. Pylori
37
A sign of adenocarcinoma metastasis supraclavicular Lymph node is known as ?
Virchow's Node
38
Type of bilirubin not soluble in water therefore sent to liver for excretion
Unconjugated Bilirubin (Indirect)
39
Water soluble Bilirubin that can be excreted through bile
When in excess gets cleared through urine as Urobilin.
(Urine- 1st needs conversion to urobilinogen in GI)
Conjugated Bilirubin (Direct)
40
Bilirubin without increased LFTs =
Familia Bilirubin D/O
41
Hereditary unconjugated (indirect) hyperbilirubinemia
Neonatal jaundice with progress to Kernicterus
Absent UGT= Type I
Crigler-Najjar Syndrome
42
Hereditary unconjugated (indirect) hyperbilirubinemia
Transient in periods of stress: " Reduced UGT"=Mild
Gilbert's Syndrome
43
Hereditary conjugated (direct) hyperbilirubinemia
Black liver on Biopsy
Dubin-Johnson syndrome
44
LFT Pattern of liver injury (Hepatocellular damage)
Increased ALT and AST
45
Which liver enzyme is more sensitive for liver disease
ALT
46
LFT Pattern for Cholestasis
Increased ALP and GGT (Bilirubin higher than both).
47
synthesis coagulation factors dependent on vitamin K
PT
48
LFT Pattern for ETOH hepatitis
AST:ALT 2:1 Ratio "Scotch" (AST <500)
49
ALT>AST (>1,000) you think?
Acute viral hepatitis (Chronic <500)
50
Abrupt RUQ/epigastric pain. Resolves slowly lasting 30-hours. Nausea precipitated by fatty foods or large meals
Dx? TX?
Cholelithiasis
Dx- US Tx- Elective cholecystectomy
51
Gallstones in the common bile duct assoc. w duct dilation.
Dx- DOC Tx-
Choledocholithiasis
Dx- ERCP TX-ERCP stone extraction
52
Obstruction of the Biliary tract --> to biliary tract infection. MC 2T E. Coli or Klebsiella. Charcot's/Reynold
Labs: Increased ALP, GGT, and Bilirubin
Dx- Tx-?
Acute Cholangitis
Dx- CT (GS-ERCP) Tx- ABX + ERCP
53
Primary Choledocholithiasis pathophysiology cause
Stones originating @ CBD 2T Cystic Fibrosis
54
Secondary Choledocholithiasis pathophysiology cause
Passage of stones from GB into CBD (MC)
55
Inflammation/infection 2T gall bladder obstruction @ cystic duct. E.coli/Klebsiella MC.
(+) Murphy's sign RUQ pain, precipitated by fatty/large meals. DX- Initial and GS Tx-
Cholecystitis
Dx- Initial=US "GS=HIDA scan" Tx- NPO, IV, ABX,Sx
56
Chronic cholecystitis Associated with gallstones--> ?
Strawberry GB --> Porcelain GB (Premalignant condition)
57
What is Boa's sign?
Referred pain to right shoulder from irritation of the phrenic nerve in Cholecystitis
58
Rapid liver failure with encephalopathy + coagulopathy? MCC?
Fulminant Hepatitis (Acute Hepatic Failure)
MCC=Acetaminophen then Reye's syndrome
59
Encephalopathy Treatment
Lactulose- Neutralizes ammonia
ABX- decrease bacteria producing ammonia
Protein Restriction
60
Hepatitis with highest mortality during pregnancy especially during 3rd trimester?
Hepatitis E
61
Hepatitis MCC parenterally (Not common Sex/perinatal)
Hepatitis C
62
Hepatitis MCC parenterally, sexually, perinatally.
Hepatitis B
63
MC Hepatitis in the United states
Hepatitis C
64
Hepatitis Surface Antibody means
1. Distant resolved infection or 2. Vaccination
65
Hepatitis Core Antibody means? (IgM or IgG)
IgM- Acute infection IgG-Chronic infection
66
Hepatitis Surface Antigen means?
Establishes evidence of infection. (>6 months=Chronic)
67
Hepatic venous outflow obstruction (thrombosis/ occlusion). Cause- Polycythemia, OBC, prego, malignant
Dx- Tx?
Hepatic Vein Obstruction (Budd-Chiari Syndrome)
Dx- US (SOC) Tx- Shunt, B Angioplasty, diuretics
68
More commonly caused by 2ry metastasis (lung/breast)
Primary is _______
Dx- Tx-
Hepatocellular carcinoma
Primary- hepatocellular carcinoma
Dx- US and AFP Tx- Sx
69
Irreversible fibrosis with nodular regeneration MCC by alcohol. S/Sx- Pruritus Ascites, gynecomastia, HSM,
Caput medusa, palmar, erythema, "hepatic encephalopathy", Esophagus varices. Dx Tx-
Cirrhosis
Dx- US Tx- Ascites- no Na+ Pruritus-Cholestyramine
70
Hepatic encephalopathy Pathophysiology and S/Sx?
Ammonia accumulation (protein breakdown)-
Asterixis: flapping tremor (Extended wrist--> flap)
Fetor Hepaticus: Breath rotten eggs and garlic
71
Idiopathic autoimmune d/o of intrahepatic small bile ducts. Fatigue and pruritus, RUQ pain, jaundice, HSM
"Positive Antimitochondrial Antibody" Tx-
Primary Biliary cirrhosis
Tx-Ursudeoxycolic acid reduces progression
72
Diffuse fibrosis on intrahepatic ducts. Assoc. with IBD or Ulcerative colitis 2/3 patients:
"(+) P-ANCA" pruritus, RUQ pain, jaundice, HSM Tx-
Primary sclerosing cholangitis Tx ERCP
73
Free copper accumulation in liver, brain , cornea, kidney
| inadequate copper excretion Tx-
Wilson's disease
Tx- D-pencillamine + Zinc
74
epigastric constant pain that radiates to the back or other quadrants. Pain worse supine, walking or eating
MCC gallstones 2nd- ETOH. scorpion bite or mumps
Dx- SOC Tx-
Acute Pancreatitis
Dx- Ct scan Tx- NPO, IV fluids, mepiridine
75
Laboratories consistent with Acute pancreatitis
Lipase: More specific
Amylase: 3X ULN
ALT: 3X fold
Hypocalcemia
76
Parenchymal destruction and fibrosis of exocrine/endocrine function--> cancer
MCC ETOH "Lipase and Amylase not usually incr. "
Dx- Tx
Chronic Pancreatitis
Dx- AXR calcified pancreas Tx- DC ETOH
Pancreatic enzymes
77
Cramping abdominal pain, vomiting (bilious), Obstipation or high pitched BS/ visible peristalsis MCC?
Dx- Tx-
Small bowel Obstruction (MCC Post-Surgical adhesions)
Dx- AXR (dilated bowel loops)
Tx-non -strang. IV, NPO, NG decompress
Strangulated- Sx
78
Persistent portion of embryonic vitteline duct: 2 YOA
| 2% population, 2 feet from ICV, 2" in length, 2 tissues,
Meckel's Diverticulum Tx- Sx
79
Abdominal pain, NV (bilious), Obstipation " decreased- no BS", post-operative MCC: DX- Tx-
Paralytic Ileus (No structural obstruction)
Dx- AXR Tx- NPO, IV fluids, NG decompress for V
80
Colonic pseudo obstruction MC at cecum or right hemi colon. Abdominal distention = hallmark men > 60 yo
Ogilvie's Syndrome
81
small bowel autoimmune inflammation --> villi loss and impaired absorption.
Celiac Disease
82
SOC for Celiac Diagnosis?
Treatment
Small Bowel Biopsy (+) Endomysial IgA
(+) Transglutaminase Ab
Tx- Gluten Free diet ( no Rye, wheat Barley)
83
Loose stools, abdominal pain, flatulence, borborygmic after ingestion.
Dx- SOC Tx-
Lactose intolerance
Dx- Hydrogen Breath Test Tx- Lactase Enzyme preps
84
Abdominal pain 1 day /week for past 3 mos with altered defecation/ bowel habits. Diarrhea/constipation/both.
pain often relieved by defecation. Tx-
Irritable Bowel Syndrome
Tx- stop smoking, low fat diets, no fructose Amitriptyline
85
Inflammatory bowel disease includes?
Ulcerative colitis
Chron's disease
86
From Mouth to Anus: MC in terminal ileum. Transmural; Skip lesions: cobblestone appearance. "String sign" Ba
(+)ASCA: S/Sx- Non Bloody diarrhea, RLQ pain MC, weight loss Tx
Crohn's Disease
Dx- AXR Tx- Non-curative
87
Limited to colon, rectum always involved: Uniform inflammation rectum/colon: --> toxic megacolon
Smoking Decreases risk: S/Sx- bloody/mucus/pus diarrhea, hematochezia, tenesmus, (+) PANCA Tx-
Ulcerative Colitis
Dx- Flex sigmoidoscopy Tx- Curative
AXR- Stove pipe (loss of haustra)
88
Inflammatory Bowel Disease pharmacotherapy Tx
Tx- 5 ASA (Mesalamine or Sulfasalazine)
Corticosteroids (PO PR)
Methotrexate
Anti-TNF (-mabs)
89
Colon Polyps that tend to be malignant
```
#1: >1cm
#2: Sessile and Villous
#3: due to IBD (Familial Adenomatous Polyposis)
```
90
Colorectal Diagnostic of choice (DOC)
#1. Colonoscopy with biopsy
#2 Barium apple core lesion
#3 Carcinoembryonic Antigen (CEA)
91
Colorectal screening recommendations?
Annually Occult Fecal (Flex q 5 years)
FOB @ 50 : Colonoscopy @ 50 then q 10 years
FOB @ 40 (1st relative >60) colonoscopy q 10 years
FOB @ 40 (1st relative < 60) Colonoscopy q 5 years
92
Hernia that protrudes at the internal inguinal ring: the origin of the sac is lateral to inferior epigastric artery.
MC overall: MC in men (children and young adults)
2T persistent patent process vaginalis
Indirect Inguinal Hernia
93
Protrusion of contents through the abdominal cavity through the femoral canal below the inguinal ligament.
MC in women. often incarcerate or strangulate.
Femoral Hernias
94
due to failure of umbilical ring: Observation, usually resolves by ____ age?
Surgical repair if persistent past ____ of age
Umbilical Hernia
Resolves: by age 2 yoa Surgical repair if > 5 yoa
95
Protrudes medial to inferior epigastric vessels w/I Hasselbach's triangle. 2T weakness of inguinal canal
Does not reach scrotum
Direct Inguinal Hernia
96
MC occurs in vertical incisions and obese patients
Incisional (Ventral) Hernias
97
Rare where abdominal pelvic contents protrude through the obturator foramen
Obturator Hernia
98
Classification of Hemorrhoids
Class I- no prolapse
Class II- Prolapse but spontaneously reduces
Class III- Prolapse only reduced manually
Class IV- Non-reducible
99
Hemorrhoid Treat conservative?
| Within 72 hrs or failed conservative?
Conservative- high-fiber, topical CS, sitz baths
Ligation or sclerotherapy (Injection)
Within 72 hours- Hemorrhoidectomy
100
Tunnel that forms in skin at anus/rectum?
Anorectal Fistula
101
anorectal swelling with pain that is worse with sitting, coughing, or defecation.
Anorectal Abscess
102
Painful linear tear/crack in the anal canal involving only epithelium without mucosa. 3 or 9'0clock= ______?
Severe rectal and BM pain--> refrain BM-->constipation with bright red blood per rectum. MC__?
Anal Fissure
MC posteriorly (3 0r 9'oclock = Malignancy or Crohn's)
103
Gluteal Cleft tender abscess with drainage
Pilonidal Cyst/Abscess/ Sacrococcygeal fistula
104
accumulation of a byproduct of proteins--> accumulation. "Urine with musty odor (Mousy-brownish)"
Phenylketonuria
Avoid Phenylalanine or Tyrosine
105
Deficiency leads to 3 Hs- Hemorrhage (gums, skin joints), hyperkeratosis, hematologic issues (anemia, Incr. bleed time)
Vitamin C deficiency (Scurvy)
106
Deficiency leads to night blindness, poor wound healing, taste loss, dry skin. needed 4 embryo develop.
Vitamin A deficiency
107
Deficiency can lead to rickets in children and _______ in adults? Tx?
Vitamin D Deficiency (Osteomalacia)
Tx- Ergocalciferol
108
MCC of deficiency is ETOH abuse.
Vitamin B1 Deficiency (Thiamine)
109
Vitamin B1 Deficiency (Thiamine) --> what 3 D/O
Beri-Beri
Wernicke's
Korsakoff's dementia
110
Wet vs. Dry Beri-Beri
Wet- High output HF (Dilated cardiomyopathy
Dry- Neuro Paresthesia's and demyelination
111
Wernicke's Triad
Ataxia, global confusion, ophthalmoplegia (ocular paralysis)
112
Korsakoff's pathophisiology
irreversible memory loss (Tio Guero)
113
Deficiency leads to oral-ocular-genital syndrome.
| Magenta tongue/cheilitis, photophobia/cornea lesion, scrotal dermatitis
Vitamin B2 (Riboflavin)
114
deficiency often due to diet high in corn. --> pellagra
| 3D's Dementia, dermatitis, diarrhea
Vitamin B3 (Niacin/nicotinic acid)
115
Deficiency leads to peripheral neuropathy:
| isoniazid, OBC, chronic ETOH
Vitamin B6 (Pyridoxine)
116
Deficiency leads to neuro- dementia, gait, paresthesias: 2T pernicious anemia, vegans, ETOH abuse,
Celiac/crohn's and Gastric bypass malabsorption.
Vitamin B12 (Cobalamin)
117
MCC pathogen overall gastroenteritis in adults in N. America (Cruise ships, hospitals, restaurants)
Norovirus
118
MCC pathogen of non-entero toxin non- bloody diarrhea in children 70%
Rotavirus
119
Short incubation periods < 6hours--> voluminous non-bloody diarrhea dairy, mayonnaise, meat, eggs
S. Aureus
120
Similar to staph A. IP 4-6 hours MC in contaminated fried rice
Bacillus Cereus
121
Gram negative rod--> hypersecretion of water/Cl- ions--> severe dehydration. Poor sanitation and crowding
Copious "Rice Water" grey no fecal odor/blood/pus
Lose 15L /Day of fluid. Tx-
Vibrio Cholera
Fluid replacement Abx-fluroquinolones
122
Associated with Raw Shellfish in Gulf of Mexico
Vibrio Vulnificus
123
MCC of traveler's diarrhea. Unsanitary drinking of water/ice. Tx-
Enterotoxigenic E. Coli
Tx- Severe= Fluoroquinolone (non= Bismuth/Fluids)
124
Organism growth secondary to alteration of normal Flora 2T ABX use. Fever, diarrhea, tenderness, Tx?
ABX MCC is ______
Clostridium Difficile
Tx-Vancomycin 1st if severe (Metronidazole)
MCC Abx= Clindamycin
125
MCC of bacterial enteritis in U.S. Antecedent to Guillian- Barre syndrome. S, comma, seagull shaped.
TX- TOC Abx?
Campylobacter Enteritis
Tx- Erythromycin
126
Highly virulent explosive watery diarrhea--> mucoid/bloody. May lead to toxic megacolon
Febrile seizures in children. Dx- CBC > 50K: Sigmoid w punctate areas of ulceration. Tx
Shigella Toxin
Tx- Septra
127
Greatest in the summer: MC poultry, reptiles, dairy, meat eggs. Feco-oral
Salmonella
128
presents with headache, constipation, pharyngitis, cough, abdominal pain, "pea soup Diarrhea"
intractable Fever, bradycardia, "Blanching rose spots"
Typhoid Enteric Fever (Salmonella Typhus)
Tx Cipro, ceftriaxone
129
High risk in immuno-comp patients. In sickle cell patients it leads to ________?
Salmonella
--> Osteomyelitis
130
Source- from undercooked ground beef, unpasteurized milk/cider, daycare contaminated water. Bloody diarrhea
Tx- if severe
Enterohemorrhagic E. Coli 0157:H7
Tx- Abx--> HUS in children
131
contaminated pork, milk, water, Tofu: Appendicitis mimic
| produces abdominal tenderness and guarding
Yersinia Enterolitica
132
Contaminated water from remote streams. Backpacker/Beaver fever. Frothy greasy foul diarrhea
Tx-
Giardia Lamblia
Tx- Boil water x1 minute Metronidazole
"Furizoladine (Children)"
133
Fecal oral transmitted: Traveler's in developing nations.
| --> liver abcesses
Amebiasis
Tx-Metronidazole
134
MCC of chronic diarrhea in patients with AIDS. Fecal Oral
Cryptosporidium
135
MC in homosexual men fecal oral
Isospora Belli
136
MC in farmers around contaminated soil. --> malabsorption, weigh loss, steatorrhea,
Rhythmic motion of eye muscles while chewing
Whipple's Disease
137
Bulk forming laxatives
Psyllium, Methylcellulose, wheat Dextran
138
Osmotic Laxatives- Side effects= Bloating and Flatulence
Polyethylene Glycol (Miralax)
Milk Magnesia
Magnesium citrate
139
Stimulant Laxatives
Bisacodyl/Senna
140
Stool softener laxatives
Docusate
