Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Knowledge Success Journal > GASTROENTEROLOGY > Flashcards

GASTROENTEROLOGY Flashcards

1
Q

Which conditions show dysphagia to solids AND liquids

A

MOTILITY/NEUROLOGICAL conditions
-DES
-Achalasia
-Systemic sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which conditions show dysphagia to solids THEN liquids

A

ANATOMIC conditions
-stricture (progressive)
-cancer (progessive)
- schatzki ring (intermittent)

DX: EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is dyspepsia. What is managment for individual <60yrs with no RFs

A

Dyspepsia: chronic/intermittent pain in upper abd ESPECIALLY after meals
2 options in pts w/dyspepsia and no RFs and <60yrs:
(1) Test and tx for H pylori, then
(2) Trial with PPI for 4-8 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is tx for H pylori

A

(1) No previous macrolide use/ macrolide-resistance low: triple therapy–>omeprazole+ ampicillin +clarithromycin for 14 days

All others receive:
(1) levofloxacin triple therapy for 14 days
(2) bismuth quardruple tx for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is bismuth quadruple tx for H pylori

A

bismuth + metronidazole + tetracyline + PPI for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is levofloxacin triple tx for H pylori

A

levo + amoxicillin + PPI for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List characteristics of achalasia. What about pseudo achalasia?

A

ACHALASIA:
-dysphagia solids AND liqs
-regurge WORSE AT NIGHT
-long standing (usu years)
-Dx: barium swallow (bird’s beak), EGD (r/o obstruction), manometry (confirms)
-Tx: opening/relaxing LES –>surgery or dilation. IF poor surgical candidate, botulism toxin

Think PSEUDOACHALASIA
-Same sx as achalasia BUT
-wt loss
->60yrs
-progressive
-Dx: EGD!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List characteristics of Diffuse Esophageal Spasm

A

DES
-spasms, precipitated BY COLD
-Dx: barium swallow (corkscrew pattern IF done at time of spasms)
-Tx: reassurance. IF want more
(1st line): CCB
(2nd line): isosorbide, sildenafil
(3rd line): bot injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is acute cholangitis? What 3 things do you expect to see?

A

ACUTE CHOLANGITIS
-inflammation of the bile ducts 2/2 stones
-Sx: (1) biliay colic (2)jaundice (3) fever w/chills
-Tx: β-lactam/β-lactamase inhibitor or a third-generation cephalosporin plus metronidazole + ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe PBC–sx, dx, tx, associated dx

A

PRIMARY BILIARY CHOLANGITIS
-progressive, autoimmune liver dx
-women aged 40-60yrs

(1) Symptoms: fatigue, wt loss, hyperpigmentations
(2) Diagnosis: +antimicrobial antibody, alk phos >=1.5 ULN
(3) Tx: Ursodeoxycholic acid
(4) Associated dx: thyroid dx (TSH q1yr); DEXA; men/or pts w/cirrhosis–screen for hepatocellular cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe PSC–sx, dx, tx, associated dx

A

PRIMARY SCLEROSIS CHOLANGITIS
-progressive liver dx charac by bile duct destruction/billiary dx
(1) Symptoms: pruiritis, elevated Alk phos, elevated total bil,
(2) Dx: MRCP –“string of beads”
(3) Tx: liver transplantation
(4) Associated dx: IBD (85% UC) –>colon cancer (colonoscopy q2yrs); gallbladder cancer; cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Periumbilical pain that becomes RLQ pain + fever should make you think of what condition

A

Appendicitis
-starts periumbilical and then migrates to RLQ
-note: iverticulitis–>LLQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe carcinoid syndrome

A

CARCINOID SYDROME
-Conditions causing increased cortisol (including carcinoid dx)
-Sx: flushing, hypotension, tachycardia, explosive diarrhea + NIACIN deficiency (rash, thickened tongue, angular chelitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe Chron’s dx vs Ulcerative Colitis. What 4 sx do you see w/Chron’s

A

CHRON’S
-more indolent, less responsive to tx
-more likely to have strictures, inflammatory masses, associated obstruction
-4 Sx: (1) rectal SPARING (2) skip lesions (3) perianal dx (4) ileocecal involement
-DX: endoscopic findings of pathchy, focal, transmural ulcers. +granulomas +/- string sign.
-LAB: ASCA
-Extraintestinal: Osteoperosis (2/2 chronic steroid use)

UCLERATIVE COLITIS
-inflammation ALWAYS starts in rectum–extends proximally; CONFINED to colon
-continuous mucosal inflammation w/shallow ulcers
-Sx: abdominal pain + bloody diarrhea +/- tenesum (painful anal spasms) +/- constipation
-LAB: p-ANCA
-Extraintestinal: “Joints-skin-eyes-mouth” –> skin lesions (erythema nodosum/pyoderma gangrensum), joints (anklosising spondylitis, RF-negative polyarthritis), eyes (iritis), mouth) apthous ulcers) ALSO PSC (think jaundice, itching, cholestatic LFTs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe Whipple disease–sx, dx, tx

A

WHIPPLE
-caused by bacteria: gram + T whipple. Bacteria obstruct lympatics in intestine which cause malabsorption.
-Sx: 4 things (1) abdominal pain (2) diarrhea (3) wt loss (4) joint pain +NEURO sx
-Dx: foamy macrophages, + PAS
-Does NOT improve w/gluten free diet. No villi blunting on bx
-Tx: IV ceftriaxone, yr of bactrim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe olmesartan-induced enteropathy

A

This ARB causes sx IDENTICAL (clinical and histopathologically) to celiac. Has FDA black box warning!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe TROPICAL SPRUE

A

TROPICAL SPRUE
-Caused by an unknown organism
-Megaloblastic anemia (B12 deficiency); travel to equatorial areas
-does NOT improve w/gluten free diet. Villi blunting on bx
-Tx: tetracycline or doxycycline x 6mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What skin condition and anemia is strongly associated with CELIAC SPRUE

A

CELIAC SPRUE (aka Celiac Disease, nontropical sprue)
-DERMATITIS herpetiformis–tx w/dapsone
-Iron deficiency (microcytic anemia–2/2 iron being absorbed in the duodenum)
-DOES improve with gluten free diet. Villi blunting on bx

**Note, tropical sprue associated w/megaloblastic anemia (B12 deficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe celiac dx (nontropical sprue)

A

CELIAC
-inflammatory response to dietary gluten that damagess intestinal mucosa
-dx: antibodies (IgA anti-tissue transglutaminase); anti DGP in case of IgA deficiency
-Tx: gluten free diet

EXTRAINTESTINAL MANIFESTATIONS
-DM1, adrenal insufficiency
-dermatitis herptiformis (responds to dapsone)
-osteoperosis
-neuropathies
-non-hodgkin lymphoma
-thyroid/esophageal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do you generally treat invasive diarrhea with? What 2 bugs are the exception

A

GENERALLY tx invasive diarrhea with quinolones (esp ciprofloxacin) BUT macrolides for campy and metronidazole for amebiasis

EXCEPTIONS–NO abx:
1) EHEC –> symptomatic tx only. Abx incr risk for TTP/HUS!
2) Salmonella–>symptomatic tx only. Abx may prolong infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do you generally treat invasive diarrhea with? What 2 bugs are the exception

A

GENERALLY tx invasive diarrhea with quinolones (esp ciprofloxacin) BUT macrolides for campy and metronidazole for amebiasis

EXCEPTIONS–NO abx:
1) EHEC –> symptomatic tx only. Abx incr risk for TTP/HUS!
2) Salmonella–>symptomatic tx only. Abx may prolong infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What kind of bilirubin is elevated in Gilbert syndrome

A

Unconjugated = indirect= without bilirubinemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe hemochromatosis.

A

Hemochromatosis:
-autosomal recessive; increased intestinal absorption of IRON
-Labs: transferrin saturation, serum ferritin
-Tx: phlebotomy
-f/u: screen for HCC q6mos if cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe Wilson’s dx

A

Wilson’s dx:
-autosomal recessive; decr excretion of COPPER
-Sx: hx of psychiatric disorders, and/or cathetoid movements
-Labs: (1) elevated urine copper (2) low serum ceruplasmin (3) slit lamp eye exam –>Kayser Fleischer rings +hemolytic anemia +elevated alkphos
-Tx: D-pencillamine

*elevated copper in PBC, PSC**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you tx autoimmune hepatitis (AIH)?

A

prednisone/budenosine +/- azathioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What demographics are generally invovled with PSC, PBC, and autoimmune hepatitis

A

PSC: middle-aged men
PBC: middle-aged woman
Autoimmune hepatitis: young woman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What hepatitis is associated with leukocytoclastic vasculitis

A

HCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe Irritable bowel SYNDROME

A

IBS
-Note, it’s NOT inflammatory bowel dx (IBD –Chron’s, UC)
-Sx: alternating constipation/diarrhea w/normal colonoscopy +/- abd pain
-dx: sx for >3mos with @ least 2 of the following: pain-related defecation, change in stool consistency, change in stool frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which is preferred feeding in ICU setting?

A

ENTERAL feeds
-maintains intestinal epithelium
-refers to any feeding that uses GI tract to deliver nutrients
(parenteral refers to deliver of nutrients via vein)

30
Q

What 3 drugs should you STOP in pts with ascities

A

STOP in pts w/ascities:
1) NSAIDS
2) ACE-I
3) ARB

31
Q

Describe two types of diverticulum–esophagus, small intestines.

A

ZENKER DIVERTICULUM
-outpouching in esophagus
-Sx: halitosis, regurged food
-Dx: Barium esophagography
-Tx: Surgery

MECKEL’s DIVERTICULUM
-outpouching of intestine
-Sx: bloody stool–gastric enzymes get trapped in pouch, leads to ulcers, which bleed; NONpainful bleeding
-Dx: Meckel scan
-Tx:

32
Q

Describe diverticulitis

A

DIVERTICULITIS
-inflammation of outpouchings in intestines
Sx:LLQ pain +FEVER + WBC. No bleeding
Dx: CT abdomen
Tx: gram- AND gram +
-mild: metronidazole (gram-) + cipro (gram +)
-moderate/severe: dual tx best

***Current guidelines based on high-quality evidence strongly recommend that antibiotics be avoided in select patients with uncomplicated diverticulitis.
** Intravenous antibiotics with activities against gram-negative rods and anaerobic organisms are required in patients who cannot tolerate an oral diet; patients with severe comorbidities, advanced age, or immunosuppression; and patients for whom oral antibiotics have been ineffective.

33
Q

Describe Acute mesenteric ischemia (AMI)

A

ACUTE MESENTERIC ISCHEMIA
-p/w abrupt onset of severe periumbilical abdominal pain + URGE TO DEFECATE.
-Pain that is disproportionate to physical examination findings should immediately raise suspicion for early AMI.
-Dx: CT angiography (FOR ACUTE)
**Note: CT abdomen +IV contrast usu 1st option for colonic ischemia

34
Q

Describe ischemic colitis vs acute mesenteric ischemia

A

ISCHEMIC COLITIS
-Cause: low-flow states (hypotension, HF)/drugs (cocaine)
-Sx: LLQ pain + bloody diarrhea
-Dx: CT abdomen (w/ contrast)
-Tx: Supportive care w/ IVF + bowel rest
**CT findings are nonspecific, including segmental bowel wall thickening and pericolonic fat stranding, often in the distribution of the “watershed” areas of the colon (splenic flexure and rectosigmoid junction)

ACUTE MESENTERIC ISCHEMIA
-Cause: emboli (most common)
-Sx: severe periumbilical pain out of proportion to exam
-Dx: CT angio
-Tx: surgery

35
Q

What sort of cancer do you get w/Barretts esophagus

A

ADENOCARCINOMA

36
Q

Describe Barretts esophagus

A

BARRETTS ESOPHAGUS
RFs: long hx GERD, male, white, family hx
Dx: EGD with bx
Tx: mucosal resection for any dysplasia ( low or high grade); otherwise PPI for no dysplasia
F/u: q3-5 yrs NO dysplasia. q 6mos if dysplasia.

37
Q

Neuroendocrine GI tumors mostly where

A

RECTUM

38
Q

Desc esophageal varices. Tx?

A

ESOPHAGEAL VARICES
-complication of liver cirrhosis
-enlarged vessels at base of esophagus in setting of liver cirrhosis
-Dx: EGD
-Tx: EGD –>start BB (when have varices +red whale marks) –>BB + endoscopic ligation

*PPIs have NO role

39
Q

What is 1st line tx for hemorrhoids

A

First-line therapy for hemorrhoids includes increased fiber intake, adequate liquid intake, and avoidance of straining.

40
Q

What meds are specific to Chrons. What meds are used in both UC and Chron’s

A

ONLY UC
-5-ASA: mesalamine

BOTH UC and Chron’s
-immunosuppresants
-budenosine
-IV steroids
-Azathioprine/6-MPc

41
Q

Describe UC vs Chron’s dx in the following:
-depth
-pattern
-location
-rectal involvement
-fistulas
-prominent sx

A

ULCERATIVE COLITIS
-depth: mucosal
pattern: continuous
-location: colorectum
-rectal involvement: 100%
-rectal bleeding: common
-fistulas: rare
-prominent sx: diarrhea

CHRONS
-depth: transmural
-pattern: skip
-location: mouth to anus
-rectal involvement: less common
-rectal bleeding: rare
-fistulas: COMMON
-prominent sx: abd pain

42
Q

What ulcer is seen with UC/Chron’s

A

PYODERMA GANGREOSUM

-nonhealing ulcer, often occurring on the lower extremities, may be seen in association with IBD. The ulcer shown has a purulent base and ragged, edematous borders.

43
Q

What are 6 classes of tx meds for constipation?

A

(1) serotonergic prokinetic agents
-prucalopride
(2) bulking agents
-psyllium [
(3) stimulant laxatives
-senna, bisacodyl
(4) osmotic laxatives
-polyethylene glycol, lactulose, sorbitol)
(5) stool softeners
-docusate
(6) secretagogues —lubiprostone, linaclotide, plecanatide)

44
Q

Describe surveillance of colon cancer + genetic conditions

A

GENETIC CONDITIONS:
-Familial adenomatous polyposis (FAP): autosomal dominant; requires prophylactic colectomy.
-Gardner syndrome: type of FAP w/extraintestinal manifestations (osteomas, duodenal ampullary tumors, thyroid cancers, and medulloblastomas).
-Lynch syndrome: autosomal dominant; associated with an increased risk for extracolonic tumors, most commonly endometrial.

SURVEILLANCE:
-FAP: Begin 10-12 yrs; flexible sigmoidoscopy or colonoscopy; q 1-2 yrs until colectomy
-Lynch syndrome: Begin 20-25 yrs or 10 years earlier than youngest cancer in family; colonoscopy; q 1-2 yrs
-IBD (Chron’s or UC): Begin after 8 years of chronic colitis; colonoscopy with biopsies; q 1-2 yrs

45
Q

RLQ abdominal pain +/- fever think ?

A

Appendicitis
RLQ pain +/- fever ALWAYS think of appendicitis
Rember it pts >75 yrs, sx are atypical +/- fever +/- leukocytosis

DIAGNOSIS
-Abdominal and pelvic CT is used to confirm the diagnosis.

TREATMENT
-Nonperforated (uncomplicated): preoperative antibiotics + appendectomy (12-24hrs)
-Perforated (complicated): IV abx, abscess drainage, emergent appendectomy.
-Colonoscopy should be considered to evaluate for neoplasm at follow up.

46
Q

The coexistence of GERD and peptic ulcer disease should make you think of what?

A

ZOLLINGER ELLISON SYNDROME
-see GERD, PUD +/- diarrhea + elevated gastrin
-localize site of gastrinoma –>endoscopic u/s

47
Q

Describe autoimmune pancreatitis?

A

AIP
-can p/w obstructive jaundice (yellow skin, dark urine, light stool)
-associated sclerosing cholangitis, sclerosing sialadenitis, or retroperitoneal fibrosis.
-2 types. Type 1 is systematic
-elevated IgG4
-CT findings: diffusely enlarged pancreas w/indistinct borders (“sausage shaped”)
-Tx: steroids

48
Q

What antidepressant class can be used to treat IBS-D

A

TCA (this med causes constipation so good to stop diarrhea)

49
Q

What is diagnosis of achalasia? What is treatment?

A

Diagnosis
-barium (bird’s beak) –> EGD (r/o psuedo)
-esophageal manometry (confirms)

Treatment
-Laparoscopic myotomy of the LES

50
Q

Describe schatzki ring

A
  • Dysphagia (usu meat & bread)
  • Tx: balloon or dilation
51
Q

T/F:
-Patients with ascites should discontinue ACE inhibitors and NSAIDs.
-Patient w/angioedema should d/c aCE-I

A

TRUE!! TRUE!!

52
Q

Treatment for hepatic abscess >3cm

A

1) Antibiotics
2) Hepatic abscesses 3 cm or greater in diameter typically do not resolve with antibiotic therapy alone, and aspiration of the abscess by percutaneous needle approach is warranted.

53
Q

What is diagnostic study For active lower gastrointestinal bleeding with associated hemodynamic instability

A

For active lower gastrointestinal bleeding with associated hemodynamic instability, CT angiography is the study of choice.

54
Q

Describe what layer of intestine is inovlved in Chrons vs UC? Which condition is extraintestional manifestations more common?

A

CHRONS
-transmural
-extraintestinal more common

UC
-mucosal layer only

Extraintestinal manifestations:
-arthralgia, back pain (indicating ankylosing spondylitis or sacroiliitis), and oral aphthous ulcers.
-Eye: uveitis, iritis, or episcleritis.
-Skin: pyoderma gangrenosum and erythema nodosum
-Liver: PSC

55
Q

Review treatment for UC

A

Consider 3 factors:
-disease severity, distribution, and previous tx response.

MILD/MODERATE
-IF proctitis: 5- ASA (suppository); delivers to rectum only
-IF L-sided colitis: 5-ASA (enema)
-IF poor resp: 5-ASA (oral); L-sided colititis

EXTENSIVE
-combined 5-ASA tx (oral and topical)

56
Q

Tx of maintenance therapy for UC?

A

Combination therapy with infliximab and azathioprine is more efficacious than monotherapy with either agent alone in achieving glucocorticoid-free remission and mucosal healing in ulcerative colitis.

do NOT use steroids

57
Q

For adrenal masses incidentally found–when is surgery recommended?

A

Surgery is recommended for adrenal masses >4 cm in diameter or functioning tumors.

58
Q

describe different types of dysphagia?

A

PROGRESSIVE dypshagia to liq and solid: achalasia or scleroderma

PROGRESSIVE dyphagia to solids 1st, then liquids: cancer or stricture

INTERMITTENT dyphagia to solids: webs or rings

59
Q

What are lab abnormalities for primary adrenal insufficiency

A

LOW Cortisol
-hyperkalemia
-hyperpigmentation (high aCTH)
-hyponatremia

60
Q

When do you use dexamethasone for adrenal insufficiency

A

For acute only. NOT for chronic replacement
-4 mg IV dexamethasone

61
Q

What enteric pathogen is characterized by flask-shaped enteric ulcers on microscopic evaluation on intestinal bx

A

Entamoeba histolytica

62
Q

What is treatment for acute colonic pseudo-obstruction.

A

TREATMENT
-conservative 1st–> IV neostigmine (stimulates colonic motility)
-colonic decompression: IF failed conservative and neostigmine
*Note: surgery RARELY indicated

63
Q

For a patient w/GERD, when do you eval with EGD

A

1) sx refractory to PPI
2) red alarm sx (wt loss, odnophagia, dysphagia)

64
Q

Colonoscopy screening: 10 yrs vs 3 yrs vs 1 yr?

A

10 years
-NORMAL

3 years
-5 to 10 tubular adenomas <10mm
>=1 advanced ademoa (>10mm, villous/rublovillous, high-grade)

1 year
>10 adenomas

65
Q

What are 2 main treatments for IBS-C

A

*Bulking agents
-polyethylene glycol (PEG)

  • New agents/secretagogues
    -lubiprostone, linaclotide, plecanatide
66
Q

Describe tx of UC using 5-ASA

A

LEFT-sided UC
-5-ASA ENEMAs

Mild/Mod UC
-5-ASA suppositories

67
Q

diverticulitis + abscess–what is management of abscess

A

IF abscess <4cm: observe
IF abscess > 4cm: surgery

68
Q

Desc severe alcoholic hepatitis. What is the treatment?

A

ALCOHOLIC HEPATITIS
-h/o excessive alcohol consumption, low-grade fever, jaundice, tender hepatomegaly, an aspartate-to-alanine aminotransferase ratio greater than 2, and a Maddrey discriminant function score of >=32

TREATMENT
In the absence of systemic infection, acute kidney injury, uncontrolled gastrointestinal bleeding, and multiorgan failure, PREDNISOLONE is the treatment of choice for severe alcoholic hepatitis.

*No longer use pentoxifylline

69
Q

Describe tx for the following cirrhosis complications
-hepatic encephalopathy tx/ppx
-SBP tx/ppx
-GIB tx/ppx

A

variceal bleeding
-active bleed tx: octreotide
-ppx: BB

Hepatic encephalopathy
-tx: lactulose +/- rifaxime
-ppx: lactulose

SBP
-tx: cefotaxime and albumin infusion
-ppx: fluoroquinolones

70
Q

Desc acute cholecystitis

A

-gallbladder inflammation +/- infx
Sx: severe RUQ or epigastric pain lasting (>6hrs) + fever
Dx: u/s (ultrasound showing gallbladder-wall thickening or edema and sonographic Murphy sign.)
Tx: ABx (same as acute cholangitis –> β-lactam/β-lactamase inhibitor or a third-generation cephalosporin plus metronidazole) + Surgery before hospital discharge

71
Q

When do you use a HIDA scan?

A

ACUTE CHOLECYSTITIS
-Hepatobiliary iminodiacetic acid (HIDA) scanning can be used when the diagnosis of acute cholecystitis is unclear, such as when symptoms are consistent with cholecystitis yet the ultrasound is normal. The classic finding of acute cholecystitis on a HIDA scan is nonvisualization of the gallbladder due to cystic duct obstruction.

Knowledge Success Journal (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions