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PANCE > Gastro > Flashcards

Gastro Flashcards

1
Q

Secreted by parietal cells

A

Hydrochloric acid

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2
Q

Digests proteins secreted by chief cells

A

Pepsin

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3
Q

Stimulates stomach acid secretion and motility.

secreted by G cells

A

Gastrin

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4
Q

directly stimulates parietal cells to secrete Hydrochloric acid

A

Acetylcholine

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5
Q

Inhibits parietal cell gastric secretion and buffers acid chime leaving the stomach

A

Secretin

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6
Q

Stimulates bile release and amylase/lipase for fat and protein breakdown

A

Cholecystokinin

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7
Q

Suppresses the release of GI hormones: inhibits secretion of gastrin

A

Somatostatin

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8
Q

Produced by pancreatic Alpha cells

Beta cells

A

Glucagon

Insulin

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9
Q

Water soluble contrast used in upper GI study when perforation is suspected

A

Gastrografin (Replacing Barium)

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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

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11
Q

Linear white plaques esophagitis and Tx?

A

Candida

Tx- PO Fluconazole

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12
Q

small deep ulcers esophagitis and Tx?

A

HSV

Tx- Acyclovir

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13
Q

Large superficial shallow ulcers esophagitis?

A

CMV

Tx- Ganciclovir

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14
Q

Pill induced esophagitis MCC

A

NSAIDS, Bisphosphonates, Potassium chloride, Iron pills, BBs, CCBs.

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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

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16
Q

GERD: _____ cells replaced by _______ cells can lead to what kind of carcinoma?

A

Squamous to Columnar cells (Barret’s Esophagus)

Adenocarcinoma

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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

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18
Q

Excessive contraction during peristalsis. Normal Esophagram and EGD

Dx-

Tx-

A

Nutcracker Esophagus

Dx- Manometry

Tx- CCBs, Nitrates, Botox, sildenafil

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19
Q

Dysphagia, regurgitation of undigested food, choking sensation, halitosis.

Dx-

Tx-

A

Zenker’s Dicerticulum

Dx- Barium Esophagram

Tx- Diverticulectomy Sx

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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

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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)

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22
Q

lower esophageal constrictions/webs @ squamo-columnar jx. MC associated with Hiatal hernias

A

SCHATZKI Ring (Esophageal Web/Ring)

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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)

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24
Q

MC type of hiatal Hernia

A

Sliding Type 95% (GE Junction + stomach slide)

(Rolling- (paraesophageal) Fundus of stomach protrudes through diaphragm.

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25
Q

MC Esophageal Neoplasm @ ____ 1/3?

Usually complication of GERD–> Barret’s DX-?

A

Adenocarcinoma: Upper 1/3

EGD with Bx

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26
Q

MCC of gastritis: 2nd MCC and 3rd?

Epigastric pain, NV, anorexia, hematemesis, melena.
DX- ?

A 
#1 H. Pylori 
#2 NSAIDS
#3 Acute stress

Dx- Endoscopy GS

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27
Q

H. Pylori positive Triple therapy

A

(CAP)
Clarithromycin
Amoxicillin
PPI

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28
Q

Burning, gnawing, hunger like epigastric pain, worse at night: worse/ food provoked 1-2 hours after meal

A

Gastric Ulcer Peptic Ulcer disease

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29
Q

Burning, gnawing, hunger like epigastric pain, worse at night: relieved with food, antacids.

A

Duodenal Ulcer Peptic Ulcer disease

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30
Q

H. Pylori Testing gold standard?

MC used? and which confirms eradication

A

Endoscopy with Biopsy

MC used= Urea Breath test Eradication= Stool Ag

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31
Q

Sudden onset severe diffuse abdominal pain. Rigid abdomen with rebound tenderness think______

MC?

A

Duodenal Ulcer perforation

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32
Q

Quadruple H. Pylori therapy?

A

BTM-P

Bismuth Subsalicylate, Tetracycline, Metronidazole, PPI

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33
Q

Medication forms viscous adhesive coat that protects and promotes healing of mucosa

A

Sucralfate

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34
Q

Medication used in Esophageal varices that is a somatostatin analog–> vasoconstriction of portal vein

Decreases Gastrin/ Reduces bleeding

A

Octreotide

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35
Q

Gastrin secreting neuroendocrine tumors–> gastric acid hypersecretion–> PUD Kissing Ulcers” both sides lumen

Dx and Tx

A

Zollinger-Ellison Syndrome

Dx- Increased Fasting Gastrin Levels + pH<2

Tx- Sx

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36
Q

MC Gastric carcinoma WW?

Most important RF is _____

A

Adenocarcinoma

H. Pylori

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37
Q

A sign of adenocarcinoma metastasis supraclavicular Lymph node is known as ?

A

Virchow’s Node

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38
Q

Type of bilirubin not soluble in water therefore sent to liver for excretion

A

Unconjugated Bilirubin (Indirect)

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39
Q

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)

A

Conjugated Bilirubin (Direct)

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40
Q

Bilirubin without increased LFTs =

A

Familia Bilirubin D/O

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41
Q

Hereditary unconjugated (indirect) hyperbilirubinemia

Neonatal jaundice with progress to Kernicterus
Absent UGT= Type I

A

Crigler-Najjar Syndrome

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42
Q

Hereditary unconjugated (indirect) hyperbilirubinemia

Transient in periods of stress: “ Reduced UGT”=Mild

A

Gilbert’s Syndrome

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43
Q

Hereditary conjugated (direct) hyperbilirubinemia

Black liver on Biopsy

A

Dubin-Johnson syndrome

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44
Q

LFT Pattern of liver injury (Hepatocellular damage)

A

Increased ALT and AST

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45
Q

Which liver enzyme is more sensitive for liver disease

A

ALT

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46
Q

LFT Pattern for Cholestasis

A

Increased ALP and GGT (Bilirubin higher than both).

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47
Q

synthesis coagulation factors dependent on vitamin K

A

PT

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48
Q

LFT Pattern for ETOH hepatitis

A

AST:ALT 2:1 Ratio “Scotch” (AST <500)

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49
Q

ALT>AST (>1,000) you think?

A

Acute viral hepatitis (Chronic <500)

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50
Q

Abrupt RUQ/epigastric pain. Resolves slowly lasting 30-hours. Nausea precipitated by fatty foods or large meals

Dx? TX?

A

Cholelithiasis

Dx- US Tx- Elective cholecystectomy

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51
Q

Gallstones in the common bile duct assoc. w duct dilation.

Dx- DOC Tx-

A

Choledocholithiasis

Dx- ERCP TX-ERCP stone extraction

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52
Q

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-?

A

Acute Cholangitis

Dx- CT (GS-ERCP) Tx- ABX + ERCP

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53
Q

Primary Choledocholithiasis pathophysiology cause

A

Stones originating @ CBD 2T Cystic Fibrosis

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54
Q

Secondary Choledocholithiasis pathophysiology cause

A

Passage of stones from GB into CBD (MC)

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55
Q

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-

A

Cholecystitis

Dx- Initial=US “GS=HIDA scan” Tx- NPO, IV, ABX,Sx

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56
Q

Chronic cholecystitis Associated with gallstones–> ?

A

Strawberry GB –> Porcelain GB (Premalignant condition)

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57
Q

What is Boa’s sign?

A

Referred pain to right shoulder from irritation of the phrenic nerve in Cholecystitis

58
Q

Rapid liver failure with encephalopathy + coagulopathy? MCC?

A

Fulminant Hepatitis (Acute Hepatic Failure)

MCC=Acetaminophen then Reye’s syndrome

59
Q

Encephalopathy Treatment

A

Lactulose- Neutralizes ammonia
ABX- decrease bacteria producing ammonia
Protein Restriction

60
Q

Hepatitis with highest mortality during pregnancy especially during 3rd trimester?

A

Hepatitis E

61
Q

Hepatitis MCC parenterally (Not common Sex/perinatal)

A

Hepatitis C

62
Q

Hepatitis MCC parenterally, sexually, perinatally.

A

Hepatitis B

63
Q

MC Hepatitis in the United states

A

Hepatitis C

64
Q

Hepatitis Surface Antibody means

A
  1. Distant resolved infection or 2. Vaccination
65
Q

Hepatitis Core Antibody means? (IgM or IgG)

A

IgM- Acute infection IgG-Chronic infection

66
Q

Hepatitis Surface Antigen means?

A

Establishes evidence of infection. (>6 months=Chronic)

67
Q

Hepatic venous outflow obstruction (thrombosis/ occlusion). Cause- Polycythemia, OBC, prego, malignant

Dx- Tx?

A

Hepatic Vein Obstruction (Budd-Chiari Syndrome)

Dx- US (SOC) Tx- Shunt, B Angioplasty, diuretics

68
Q

More commonly caused by 2ry metastasis (lung/breast)
Primary is _______

Dx- Tx-

A

Hepatocellular carcinoma
Primary- hepatocellular carcinoma

Dx- US and AFP Tx- Sx

69
Q

Irreversible fibrosis with nodular regeneration MCC by alcohol. S/Sx- Pruritus Ascites, gynecomastia, HSM,

Caput medusa, palmar, erythema, “hepatic encephalopathy”, Esophagus varices. Dx Tx-

A

Cirrhosis

Dx- US Tx- Ascites- no Na+ Pruritus-Cholestyramine

70
Q

Hepatic encephalopathy Pathophysiology and S/Sx?

A

Ammonia accumulation (protein breakdown)-

Asterixis: flapping tremor (Extended wrist–> flap)
Fetor Hepaticus: Breath rotten eggs and garlic

71
Q

Idiopathic autoimmune d/o of intrahepatic small bile ducts. Fatigue and pruritus, RUQ pain, jaundice, HSM

“Positive Antimitochondrial Antibody” Tx-

A

Primary Biliary cirrhosis

Tx-Ursudeoxycolic acid reduces progression

72
Q

Diffuse fibrosis on intrahepatic ducts. Assoc. with IBD or Ulcerative colitis 2/3 patients:

”(+) P-ANCA” pruritus, RUQ pain, jaundice, HSM Tx-

A

Primary sclerosing cholangitis Tx ERCP

73
Q

Free copper accumulation in liver, brain , cornea, kidney

inadequate copper excretion Tx-

A

Wilson’s disease

Tx- D-pencillamine + Zinc

74
Q

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-

A

Acute Pancreatitis

Dx- Ct scan Tx- NPO, IV fluids, mepiridine

75
Q

Laboratories consistent with Acute pancreatitis

A

Lipase: More specific
Amylase: 3X ULN
ALT: 3X fold
Hypocalcemia

76
Q

Parenchymal destruction and fibrosis of exocrine/endocrine function–> cancer

MCC ETOH “Lipase and Amylase not usually incr. “
Dx- Tx

A

Chronic Pancreatitis

Dx- AXR calcified pancreas Tx- DC ETOH
Pancreatic enzymes

77
Q

Cramping abdominal pain, vomiting (bilious), Obstipation or high pitched BS/ visible peristalsis MCC?

Dx- Tx-

A

Small bowel Obstruction (MCC Post-Surgical adhesions)

Dx- AXR (dilated bowel loops)

Tx-non -strang. IV, NPO, NG decompress
Strangulated- Sx

78
Q

Persistent portion of embryonic vitteline duct: 2 YOA

2% population, 2 feet from ICV, 2” in length, 2 tissues,

A

Meckel’s Diverticulum Tx- Sx

79
Q

Abdominal pain, NV (bilious), Obstipation “ decreased- no BS”, post-operative MCC: DX- Tx-

A

Paralytic Ileus (No structural obstruction)

Dx- AXR Tx- NPO, IV fluids, NG decompress for V

80
Q

Colonic pseudo obstruction MC at cecum or right hemi colon. Abdominal distention = hallmark men > 60 yo

A

Ogilvie’s Syndrome

81
Q

small bowel autoimmune inflammation –> villi loss and impaired absorption.

A

Celiac Disease

82
Q

SOC for Celiac Diagnosis?

Treatment

A

Small Bowel Biopsy (+) Endomysial IgA
(+) Transglutaminase Ab

Tx- Gluten Free diet ( no Rye, wheat Barley)

83
Q

Loose stools, abdominal pain, flatulence, borborygmic after ingestion.

Dx- SOC Tx-

A

Lactose intolerance

Dx- Hydrogen Breath Test Tx- Lactase Enzyme preps

84
Q

Abdominal pain 1 day /week for past 3 mos with altered defecation/ bowel habits. Diarrhea/constipation/both.

pain often relieved by defecation. Tx-

A

Irritable Bowel Syndrome

Tx- stop smoking, low fat diets, no fructose Amitriptyline

85
Q

Inflammatory bowel disease includes?

A

Ulcerative colitis

Chron’s disease

86
Q

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

A

Crohn’s Disease

Dx- AXR Tx- Non-curative

87
Q

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-

A

Ulcerative Colitis

Dx- Flex sigmoidoscopy Tx- Curative
AXR- Stove pipe (loss of haustra)

88
Q

Inflammatory Bowel Disease pharmacotherapy Tx

A

Tx- 5 ASA (Mesalamine or Sulfasalazine)
Corticosteroids (PO PR)
Methotrexate
Anti-TNF (-mabs)

89
Q

Colon Polyps that tend to be malignant

A 
#1:  >1cm
#2:  Sessile and Villous
#3: due to IBD (Familial Adenomatous Polyposis)
90
Q

Colorectal Diagnostic of choice (DOC)

A

1. Colonoscopy with biopsy

91
Q

Colorectal screening recommendations?

A

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
Q

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

A

Indirect Inguinal Hernia

93
Q

Protrusion of contents through the abdominal cavity through the femoral canal below the inguinal ligament.

MC in women. often incarcerate or strangulate.

A

Femoral Hernias

94
Q

due to failure of umbilical ring: Observation, usually resolves by ____ age?

Surgical repair if persistent past ____ of age

A

Umbilical Hernia

Resolves: by age 2 yoa Surgical repair if > 5 yoa

95
Q

Protrudes medial to inferior epigastric vessels w/I Hasselbach’s triangle. 2T weakness of inguinal canal

Does not reach scrotum

A

Direct Inguinal Hernia

96
Q

MC occurs in vertical incisions and obese patients

A

Incisional (Ventral) Hernias

97
Q

Rare where abdominal pelvic contents protrude through the obturator foramen

A

Obturator Hernia

98
Q

Classification of Hemorrhoids

A

Class I- no prolapse
Class II- Prolapse but spontaneously reduces
Class III- Prolapse only reduced manually
Class IV- Non-reducible

99
Q

Hemorrhoid Treat conservative?

Within 72 hrs or failed conservative?

A

Conservative- high-fiber, topical CS, sitz baths
Ligation or sclerotherapy (Injection)

Within 72 hours- Hemorrhoidectomy

100
Q

Tunnel that forms in skin at anus/rectum?

A

Anorectal Fistula

101
Q

anorectal swelling with pain that is worse with sitting, coughing, or defecation.

A

Anorectal Abscess

102
Q

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__?

A

Anal Fissure

MC posteriorly (3 0r 9’oclock = Malignancy or Crohn’s)

103
Q

Gluteal Cleft tender abscess with drainage

A

Pilonidal Cyst/Abscess/ Sacrococcygeal fistula

104
Q

accumulation of a byproduct of proteins–> accumulation. “Urine with musty odor (Mousy-brownish)”

A

Phenylketonuria

Avoid Phenylalanine or Tyrosine

105
Q

Deficiency leads to 3 Hs- Hemorrhage (gums, skin joints), hyperkeratosis, hematologic issues (anemia, Incr. bleed time)

A

Vitamin C deficiency (Scurvy)

106
Q

Deficiency leads to night blindness, poor wound healing, taste loss, dry skin. needed 4 embryo develop.

A

Vitamin A deficiency

107
Q

Deficiency can lead to rickets in children and _______ in adults? Tx?

A

Vitamin D Deficiency (Osteomalacia)

Tx- Ergocalciferol

108
Q

MCC of deficiency is ETOH abuse.

A

Vitamin B1 Deficiency (Thiamine)

109
Q

Vitamin B1 Deficiency (Thiamine) –> what 3 D/O

A

Beri-Beri
Wernicke’s
Korsakoff’s dementia

110
Q

Wet vs. Dry Beri-Beri

A

Wet- High output HF (Dilated cardiomyopathy

Dry- Neuro Paresthesia’s and demyelination

111
Q

Wernicke’s Triad

A

Ataxia, global confusion, ophthalmoplegia (ocular paralysis)

112
Q

Korsakoff’s pathophisiology

A

irreversible memory loss (Tio Guero)

113
Q

Deficiency leads to oral-ocular-genital syndrome.

Magenta tongue/cheilitis, photophobia/cornea lesion, scrotal dermatitis

A

Vitamin B2 (Riboflavin)

114
Q

deficiency often due to diet high in corn. –> pellagra

3D’s Dementia, dermatitis, diarrhea

A

Vitamin B3 (Niacin/nicotinic acid)

115
Q

Deficiency leads to peripheral neuropathy:

isoniazid, OBC, chronic ETOH

A

Vitamin B6 (Pyridoxine)

116
Q

Deficiency leads to neuro- dementia, gait, paresthesias: 2T pernicious anemia, vegans, ETOH abuse,

Celiac/crohn’s and Gastric bypass malabsorption.

A

Vitamin B12 (Cobalamin)

117
Q

MCC pathogen overall gastroenteritis in adults in N. America (Cruise ships, hospitals, restaurants)

A

Norovirus

118
Q

MCC pathogen of non-entero toxin non- bloody diarrhea in children 70%

A

Rotavirus

119
Q

Short incubation periods < 6hours–> voluminous non-bloody diarrhea dairy, mayonnaise, meat, eggs

A

S. Aureus

120
Q

Similar to staph A. IP 4-6 hours MC in contaminated fried rice

A

Bacillus Cereus

121
Q

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-

A

Vibrio Cholera

Fluid replacement Abx-fluroquinolones

122
Q

Associated with Raw Shellfish in Gulf of Mexico

A

Vibrio Vulnificus

123
Q

MCC of traveler’s diarrhea. Unsanitary drinking of water/ice. Tx-

A

Enterotoxigenic E. Coli

Tx- Severe= Fluoroquinolone (non= Bismuth/Fluids)

124
Q

Organism growth secondary to alteration of normal Flora 2T ABX use. Fever, diarrhea, tenderness, Tx?

ABX MCC is ______

A

Clostridium Difficile

Tx-Vancomycin 1st if severe (Metronidazole)

MCC Abx= Clindamycin

125
Q

MCC of bacterial enteritis in U.S. Antecedent to Guillian- Barre syndrome. S, comma, seagull shaped.

TX- TOC Abx?

A

Campylobacter Enteritis

Tx- Erythromycin

126
Q

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

A

Shigella Toxin

Tx- Septra

127
Q

Greatest in the summer: MC poultry, reptiles, dairy, meat eggs. Feco-oral

A

Salmonella

128
Q

presents with headache, constipation, pharyngitis, cough, abdominal pain, “pea soup Diarrhea”

intractable Fever, bradycardia, “Blanching rose spots”

A

Typhoid Enteric Fever (Salmonella Typhus)

Tx Cipro, ceftriaxone

129
Q

High risk in immuno-comp patients. In sickle cell patients it leads to ________?

A

Salmonella

–> Osteomyelitis

130
Q

Source- from undercooked ground beef, unpasteurized milk/cider, daycare contaminated water. Bloody diarrhea

Tx- if severe

A

Enterohemorrhagic E. Coli 0157:H7

Tx- Abx–> HUS in children

131
Q

contaminated pork, milk, water, Tofu: Appendicitis mimic

produces abdominal tenderness and guarding

A

Yersinia Enterolitica

132
Q

Contaminated water from remote streams. Backpacker/Beaver fever. Frothy greasy foul diarrhea

Tx-

A

Giardia Lamblia

Tx- Boil water x1 minute Metronidazole
“Furizoladine (Children)”

133
Q

Fecal oral transmitted: Traveler’s in developing nations.

–> liver abcesses

A

Amebiasis

Tx-Metronidazole

134
Q

MCC of chronic diarrhea in patients with AIDS. Fecal Oral

A

Cryptosporidium

135
Q

MC in homosexual men fecal oral

A

Isospora Belli

136
Q

MC in farmers around contaminated soil. –> malabsorption, weigh loss, steatorrhea,

Rhythmic motion of eye muscles while chewing

A

Whipple’s Disease

137
Q

Bulk forming laxatives

A

Psyllium, Methylcellulose, wheat Dextran

138
Q

Osmotic Laxatives- Side effects= Bloating and Flatulence

A

Polyethylene Glycol (Miralax)
Milk Magnesia
Magnesium citrate

139
Q

Stimulant Laxatives

A

Bisacodyl/Senna

140
Q

Stool softener laxatives

A

Docusate

PANCE (13 decks)

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