Gastroenterology Flashcards
(127 cards)
1
Q
KEY enzyme that controls the rate-limiting step in prostaglandin synthesis
A
Cyclooxygenase (COX)
2
Q
TWO principal gastric secretory products capable of inducing mucosal injury
A
Hydrochloric acid and pepsinogen
3
Q
Duodenal ulcers occur MOST often in
A
FIRST portion of the duodenum (>95%)
4
Q
Account for the MAJORITY of DUs
A
H. pylori and NSAID-induced injury
5
Q
Benign Gus are MOST often found
A
Distal to the junction between the antrum and the acid secretory mucosa
6
Q
MAJORITY of GUs can be attributed to either
A
H. pylori or NSAID-induced mucosal damage
7
Q
Two factors that PREDISPOSE to higher colonization of H. pylori
A
Poor socioeconomic status and less education
8
Q
Play a critical role in maintaining mucosal integrity and repair
A
Prostaglandins
9
Q
MOST discriminating symptom in duodenal ulcer
A
Pain that awakes the patient from sleep (between midnight and 3 AM)
10
Q
MOST frequent finding in patients with GU or DU
A
Epigastric tenderness
11
Q
Most common complication observed in PUD
A
Gastrointestinal bleeding
12
Q
SECOND-MOST common ulcer-related complication
A
Perforation
13
Q
LEAST-common ulcer-related complication
A
Gastric outlet obstruction
14
Q
MOST potent acid inhibitory agents available
A
Proton pump (H+ K+-ATPase) inhibitors
15
Q
MOST common toxicity with sucralfate
A
Constipation
16
Q
MOST common toxicity with prostaglandin analogues
A
Diarrhea
17
Q
MOST feared complication with amoxicillin, clindamycin
A
Pseudomembranous colitis (Tx: oral vancomycin, IV metronidazole)
18
Q
MOST common cause for treatment failure in COMPLIANT patients
A
Antibiotic-resistant strains
19
Q
Test of CHOICE for documenting eradication of H. pylori
A
Urea breath test (UBT)
20
Q
Operations MOST commonly performed for duodenal ulcers
A
- Vagotomy and drainage
- Highly-selective vagotomy
- Vagotomy with antrectomy
21
Q
Treatment of CHOICE for an antral ulcer
A
Antrectomy (including the ulcer) with a Billroth I anastomosis
22
Q
MOST frequent presenting complaint in recurrent ulceration
A
Epigastric abdominal pain
23
Q
CORNESTONE of therapy for patients with dumping syndrome
A
Dietary modification
24
Q
MOST commonly observed after truncal vagotomy
A
Post-vagotomy diarrhea
25
MAJORITY of gastrinomas occur within
Pancreas
26
MOST common nonpancreatic lesion (gastrinoma)
Duodenal tumors
27
MOST common cause of UGIB (50% of cases)
Peptic ulcers
28
FULL-THICKNESS tear of esophagus
Boerhaave Syndrome
29
PARTIAL-THICKNESS tear of esophagus
Mallory-Weiss tear
30
CLASSIC history of Mallory-Weiss tear
Vomiting, retching, coughing preceeding hematemesis
31
MOST important in the setting of hemorrhagic and erosive gastropathy (gastritis)
NSAIDs, alcohol, stress
32
Responsible for MAJORITY of cases of obscure GIB
Small intestinal sources of bleeding
33
MOST common cause of significant lower GIB in children
Meckel's diverticulum
34
MOST common cause of LGIB
Hemorrhoids
35
In children and adolescents, MOST common colonic cause of significant GIB
IBD and juvenile polyps
36
BEST way to initially assess a patient with GIB
Heart rate and BP
37
Test of choice in UGIB
Upper endoscopy
38
Procedure of CHOICE in LGIB unless bleeding is too massive
Colonoscopy
39
Initial test for massive obscure bleeding
Angiography
40
CLASSIC symptoms of Gastroesophageal Reflux Disease (GERD)
Water brash and substernal heartburn
41
MOST sensitive test for diagnosis of GERD
24-hr ambulatory pH monitoring
42
MAJOR risk factor for adenocarcinoma
Barrett's esophagus (metaplasia → squamous to columnar)
43
GOLD standard for confirmation of Barrett's esophagus
Endoscopic biopsy
44
MOST common cause of esophageal chest pain
Gastroesophageal reflux
45
BEST test for the evaluation of proximal gastrointestinal tract
Endoscopy/Esophagogastroduodenoscopy (EGD)
46
Typical presentation of esophageal cancer
Progressive solid food dysphagia and weight loss
47
One of the MOST common causes of steakhouse syndrome
Schatzki ring
48
Cancer involving the middle 1/3 of the esophagus, associated with smoking
Esophageal squamous cell CA
49
Cancer involving the lower 1/3 of the esophagus, associated with GERD, Barrett's esophagus
Esophageal AdenoCA
50
Characteristic symptom of infectious esophagitis
Odynophagia
51
Rule of 2's in Meckel's diverticulum
```
2% of the population
2 y/o
2 types of tissues involved
2:1 M:F ratio
2 in long
2 ft from ileocecal valve
```
52
Charcot's Cholangitic triad
Mnemonic: FPJ - Fever, abdominal Pain, Jaundice
53
Charcot's Neurologic Triad of Multiple Sclerosis
Mnemonic: SIN - Scanning speech, Intentional tremor, Nystagmus
54
Reynold's Pentad
In addition to Charcot's Cholangitic triad, also includes shock and confusion
55
Rome Criteria for Irritable Bowel Syndrome
Recurrent abdominal pain or discomfort at least 3 days per month in the last three months associated with 2 or more of the following: improvement with defecation, onset associated with a change in frequency of stool, onset associated with a change in form (appearance) of stool
56
Triad of Hepatopulmonary Syndrome
Liver disease, Hypoxemia, Pulmonary Arteriovenous Shunting
57
Triad of Choledochal cyst
abdominal pain, jaundice, abdominal mass
58
Classic Triad of Hemobilia
Biliary pain, Obstructive jaundice, Melena or occult blood in stools
59
Diagnosis of acute pancreatitis REQUIRES TWO of the following
Typical abdominal pain
3-fold or greater elevation in serum amylase and/or lipase level
Confirmatory findings on cross-sectional abdominal imaging
60
A TRIAD of findings should alert one to the possibility of HEMORRHAGE from a pseudocyst
Increase in the size of the mass
A localized bruit over the mass
Sudden decrease in hemoglobin level and hematocrit without obvious external blood loss
61
Reduction in GFR with an elevation of serum creatinine level, but it is fairly stable
Type 2 HRS
62
Alteration in mental status and cognitive function occuring in the presence of liver failure
Hepatic (Portosystemic) Encephalopathy
63
Sudden forward voluntary movement of the wrist after it is bent back on an extended arm
Asterixis or liver flap
64
Clinically innocuous entity in which a partial or complete septum (or fold) separates the fundus from the body
Phrygian cap
65
Deep inspiration or cough during subcostal palpation of the RUQ usually produces increased pain and inspiratory arrest
Murphy's sign
66
Triad of Acute Cholecystitis
Sudden onset of RUQ tenderness
Fever
Leukocytosis
67
Gallstone becomes impacted in the cystic duct or neck of the gallbladder causing COMPRESSION of the CBD, resulting in CBD obstruction and jaundice
Mirizzi's syndrome
68
Gas within the gallbladder lumen in plain abdominal films, dissecting within the gallbladder wall to form a gaseous ring, or in the pericholecystic tissues
Emphysematous Cholecystitis
69
MAJOR intrahepatic radicles
Caroli's disease
70
Passage of gallstones into the CBD
Choledocholithiasis
71
Presence of a palpably enlarged gallbladder suggests that the biliary obstruction is secondary to an underlying malignancy rather than to calculus disease
Courvoisier's law
72
Blue discoloration around the umbilicus (result of hemoperitoneum)
Cullen's sign
73
Blue-red-purple or green brown discoloration of the flanks (reflects tissue catabolism of Hb)
Turner's sign
74
Defined by the presence of histologic abnormalities, including chronic inflammation, fibrosis, and progressive destruction of both exocrine and eventually endocrine tissue
Chronic pancreatitis
75
Refers to an assessment of the severity or activity of liver disease, whether acute or chronic; active or inactive; mild, moderate, or severe
Grading
76
Reflects the level of progression of the disease, based on the degree of hepatic fibrosis
Staging
77
Indicates cirrhosis with a Child-Pugh score of >7 (Class B)
Decompensation
78
Used to assess prognosis in cirrhosis and provide standard criteria for listing liver transplantation (Class B)
Child-Pugh score
79
Used in assessing candidates for liver transplantation calculated using three noninvasive variables: INR, Serum bilirubin, Serum creatinine
MELD score
80
More specific indicator of liver injury
ALT
81
Hepatic inflammation and necrosis that continue for at least 6 months
Chronic Hepatitis
82
Caused by Hep B, B+D, C
Chronic viral hepatitis
83
Characterized by presence in the serum of HbeAg and HBV DNA levels
Replicative Phase (Hep B)
84
CLASSIC syndrome occurring in young women
Type I Autoimmune Hepatitis
85
Associated iwth Anti-LKM
Type II Autoimmune Hepatitis
86
Type II Autoimmune Hepatitis, Hepatitis C
Anti-LKM1
87
Drug-induced hepatitis
Anti-LKM2
88
Chronic hepatitis D
Anti-LKM3
89
Hemolytic anemia with spur cells and acanthocytes in patients with severe alcoholic hepatitis
Zieve's syndrome
90
Elevation of hepatic venous pressure gradient to > 5 mmHg
Portal hypertension
91
Progressive impairment in renal function and a significant reduction in creatinine clearance within 1-2 weeks
Type 1 HRS
92
Laboratory features that argue AGAINST irritable bowel syndrome
evidence of anemia
elevated sedimentation rate
presence of leukocytes or blood in stool
stool volume > 200-300ml/d
93
Saclike herniation of the ENTIRE bowel wall
true diverticulum
94
Involves only a protrusion of the mucosa through the muscularis propria of the colon
Pseudodiverticulum
95
Air-fluid level in the LLQ on plain abdominal film
Giant diverticulum of the sigmoid colon
96
Staging for perforated diverticular disease
Hinchey classification system
97
Circumferential, full-thickness protrusion of the rectal wall through the anal orifice
Rectal prolapse (proccidentia)
98
Majority of patient complains include anal mass, bleeding per rectum, and poor perianal hygiene
EXTERNAL prolapse
99
Present with symptoms of BOTH constipation and incontinence
INTERNAL prolapse
100
Involuntary passage of fecal material >10 ml for at least 1 month
Fecal incontinence
101
Incontinence to flatus and occasional seepage of liquid stool
Minor incontinence
102
Frequent inability to control solid waste
Major incontinence
103
Goodsall's Rule
Posterior external fistula will enter the anal canal in the posterior midline
Anterior fistula will enter the nearest crypt
A fistula exiting > 3cm from the anal verge may have a complicated upward extension and may NOT obey Goodsall's Rule
104
Chronic anal fissures
present for > 6 weeks
105
Characterized by cramping midabdominal pain, which tends to be more severe the higher the obstruction
Mechanical Intestinal Obstruction
106
Features of liver injury, inflammation and necrosis predominate
Hepatocellular disease
107
Features of bile flow inhibition predominate
Cholestatic (obstructive) disease
108
Alcohol seeking behavior, despite its adverse effects
Dependence
109
Visualizes only the rectum and a variable portion of the left colon, typically to 60 cm from the anal verge
Flexible sigmoidoscopy
110
Dysphagia for solid and liquid food
Suggests a motility disorder such as achalasia
111
Bird's beak appearance; aganglionic cells in the esophagus
Achalasia
112
Dysphagia for solid food
Suggestive of stricture, ring, or tumor
113
Impaired LES relaxation and absent peristalsis
Esophageal manometry: Diagnostic criteria for achalasia
114
Olive-shaped mass, non-bilous vomiting
Pyloric stenosis
115
Aganglionic cells in the colon
Hirschprung disease
116
Perception of a lump or fullness in the throat that is felt irrespective of swallowing
Globus Hystericus
117
Diffuse esophageal spasm has been characterized radiographically by
Tertiary contractions or a "corkshrew esophagus", "rosary bead esophagus'
118
GU that fails to heal after 12 weeks of therapy
| DU that does not heal after 8 weeks of therapy
Refractory peptic ulcer disease
119
Ulcer recurrence rates are higher, although the overall complication rates are the lowest of the three procedures
Highly-selective vagotomy
120
Provides the lowest rates of ulcer recurrence, but has the highest complication rate
Vagotomy with Antrectomy
121
Hypothetical gastinoma triangle (location of ~80% of gastrinomas)
Confluence of:
cystic and CBD superiorly
junction of the 2nd and 3rd portions of the duodenum inferiorly
Junction of the neck and body of the pancreas medially
122
Characterized by large, tortuous gastric mucosal folds
Menetrier's disease
123
Mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon
Ulcerative colitis (UC)
124
Can affect any part of the GIT from the mouth to the anus
Crohn's disease (CD)
125
Characteristic of CD, both endoscopically and by barium radiography
Cobblestone appearance
126
60-70% of UC patients; >5-15% of CD patients
pANCA positivity
127
60-70% of CD patients; >10-15% of UC patients
ASCA positivity
