Gastroenterology Flashcards
(152 cards)
1
Q
Liver enzymes in alcoholic Liver disease
A
AST/ALT ratio greater than two
AST is usually below 300 and almost always below 500
Patients will also have elevated GGT levels
2
Q
Two main types of dysphagia
A
Oro pharyngeal
Esophageal
3
Q
Oro pharyngeal dysphagia presentation
A
Difficulty initiating swallowing, often accompanied by coughing, drooling, or aspiration
4
Q
Esophageal dysphagia presentation
A
Characterized by delayed sensations of food sticking in the upper or lower chest
5
Q
Distinguishing between neuromuscular disorders and mechanical obstruction in dysphagia
A
Dysphagia for both solids and liquids initially would suggest a neuromuscular disorder
Dysphagia for initially solids in later liquids is indicative of mechanical obstruction
6
Q
Diagnosis of oral pharyngeal dysphagia
A
Most reliable first test is nasopharyngeal laryngoscopy
An esophagram would be indicatedto evaluate for achalasia
7
Q
Two main types of esophageal cancer
A
Squamous cell carcinoma
Adenocarcinoma
8
Q
Location of esophageal adenocarcinoma
A
Generally found in the distal to mid esophagus
9
Q
Risk factors for esophageal adenocarcinoma
A
GRD and Barrett’s esophagus
10
Q
Esophageal squamous cell carcinoma location
A
Upper esophagus
11
Q
Risk factors for esophageal squamous cell carcinoma
A
Alcohol and tobacco
12
Q
Peptic stricture pathophysiology
A
Well known complication of GER D that results from the healing process of ulcerative esophagitis
13
Q
Drugs that cause pancreatitis
A
Furosemide and thiazide diuretics
14
Q
Lactose intolerance pathophysiology
A
Occurs when there is insufficient amounts of lactase enzyme in the brush border of the duodenum, thereby resulting in the inability to break down and ingested the lactose into glucose and galactose
15
Q
Diagnosis of lactose intolerance
A
Lactose intolerance can be diagnosed with the lactose breath hydrogen test
Patient should fast for eight hours prior to the test
16
Q
Follow up colonoscopy at 10 years
A
Small rectal hyperplastic polyp’s
17
Q
Follow up colonoscopy in five years
A
One or two small less than 1 cm tubular adenoma’s
18
Q
Follow-up colonoscopy in three years
A
3 to 10 adenomas
Any adenoma greater than 1 cm
Adenoma with high-grade dysplasia or villous features
19
Q
Follow up colonoscopy in less than three years
A
More than 10 adenomas
20
Q
Definition of dyspepsia
A
Abdominal fullness or pain without significant heartburn
21
Q
Treatment of dyspepsia
A
In patients for less than 55 years of age, treatment and testing for H pylori should be performed
Patient is greater than 55 years of age, should undergo endoscopy to rule out malignancy
22
Q
Manometry findings in Scleroderma
A
Absence of peristaltic waves in the lower two thirds of the esophagus and a significant decrease in the lower esophageal sphincter tone
23
Q
Manno metric findings in achalasia
A
Significant decrease or absence of peristaltic waves and increased lower esophageal sphincter tone
24
Q
Diagnosis of SBP
A
Greater than 250 neutrophils in the a ascitic fluid
25
Treatment of hepatic encephalopathy
Lactulose
26
Components of the MELD score
Bilirubin
INR
Serum creatinine
27
Purpose of the MELD score
To determine 90 day mortality in patients with advanced liver disease
The calculation is commonly used in assessing candidate for transplant livers and TIPS placement
28
Risk of infection in patients with bleeding esophageal varices
Risk is as high as 50%
Infections can include SBP
Therefore these patients should be treated prophylactically with antibiotics. The preferred regimen involves the useof a floroquinolone for 7 to 10 days
29
Presentation of chronic mesenteric ischemia
Crampy abdominal pain that worsens with meals
Also known as intestinal angina
Patient may lose weight due to avoidance of food
30
Diagnosis of chronic mesenteric ischemia
Can be made noninvasively with CTA, MRA, or duplex ultrasound
Angiography remains the gold standard for diagnosis
31
Presentation of renal colic compared with peritonitis
Patients with renal colic tend to writhe in pain
Patients with peritonitis tend to lie flat and motionless to limit peritoneum irritation
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Presentation of peritonitis secondary to hollow viscus perforation
Sudden onset abdominal pain with significant tenderness and guarding
33
Diagnosis of peritonitis secondary to hollow viscus perforation
Upright chest x-ray
34
Management of perforated viscous
Emergency surgery
Broad-spectrum antibiotics, proton pump inhibitor's, fluid resuscitation leading up to surgery
35
Presentation of small bowel obstruction
Abdominal distention, nausea, vomiting, and intermittent abdominal pain
Complete obstruction of the intestinal lumen leads to dilation of the stomach and proximal small intestine leading to the symptoms
36
Most common cause of small bowel obstruction
Postoperative adhesion formation
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Diagnosis of diverticulitis
Abdominal CT scan
Possible findings include colonic wall thickening and stranding of the mesenteric fat
38
Treatment of mild diverticulitis
Treatment can be performed as an outpatient with a combination of Cipro and metronidazole
39
Two categories of acute mesenteric ischemia
Occlusive and nonocclusive
40
Causes of occlusive mesenteric ischemia
Embolic or thrombotic involvement of the superior mesenteric system whether artery or vein
Segmental intestinal strangulation
Volvulus
41
Causes of nonocclusive mesenteric ischemia
Hypo perfusion such as from a low cardiac output leading to splanchnic hypoperfusion and vasoconstriction
42
Presentation of acute mesenteric ischemia
Sudden onset of periumbilical pain with nausea and vomiting
Initial abdominal exam is usually normal without peritoneal signs.
Pain is often out of proportion to the exam findings
Progression of small bowel ischemia to infarction leads to a grossly distended abdomen, absent bowel sounds, and peritoneal signs
43
Lab work in acute mesenteric ischemia
Marked leukocytosis, elevated lactate, and metabolic acidosis
44
Diagnosis of acute mesenteric ischemia
CT angiogram
45
Treatment of acute mesenteric ischemia
Fluid resuscitation, correction a metabolic acidosis, broad-spectrum antibiotics, and nasogastric tube for decompression
Surgical consult is required
46
Pathophysiology of primary biliary cirrhosis
How do I immune disease that is characterized by the destruction of small and midsize bile ducts
There is progressive fibrosis and in stage liver disease can occur 5 to 10 years after the diagnosis
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Presentation of primary biliary cirrhosis
Pruritis
Jaundice
Fatigue
Hyperlipidemia with xanthomas
Osteoporosis
48
Lab work and primary biliary cirrhosis
Elevated alkaline phosphatase
49
Diagnosis of primary biliary cirrhosis
Anti-mitochondrial antibody's have high sensitivity and specificity
Diagnostic confirmation requires liver biopsy
50
Elevated lab and autoimmune hepatitis
Anti-smooth muscle antibody
51
Labs in Wilson disease
Low ceruloplasmin
Elevated AST and AL T
52
Treatment of primary biliary Cirrhosis
Ursodeoxycholic acid can slow the progression of PBC
The only curative treatment is a liver transplant
Steroids and immunosuppressive drugs are not useful despite the diseases apparent autoimmune nature
53
Presentation of bacterial enteritis
Fever and bloody diarrhea
54
Treatment of bacterial enteritis
Focus mainly on rehydration
Antibiotics are only indicated for patients with severe disease but should not be administered until EHEC has been ruled out due to the risk of HUS
55
Treatment of functional GER in infants
Should be reassured that this is normal and can thicken the formula with cereal
56
Treatment of bleeding esophageal varices
Endoscopic intervention
If multiple attempts fail, surgical shining or TIPS should be considered
57
Prevention of the esophageal varices bleeding
Nonselective beta blocker's such as nadolol or propranolol
58
Diagnosis of hepatitis B infection during the window period
IgM anti-HBc
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Presentation of intussusception
Intermittent, severe, crampy abdominal pain
Palpable sausage shaped mass on the right side of the abdomen
Current jelly stool's
60
Pathophysiology of intussusception
Telescoping of a proximal portion of the intestine into a distal portion
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Diagnosis of intussusception
Abdominal ultrasound
Characteristic finding of a target sign
Ultrasound not required and patience with obvious clinical diagnosis. These patients can go straight to treatment
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Treatment of intussusception
Air or water soluble enema
Barium enema not preferred due to higher risk of complications
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Risk factor of air enema
Perforation
Less likely than with barium enema
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Evaluation of pancreatic cyst
Endoscopic ultrasound with aspiration is the best test to differentiate between malignant and nonmalignant causes
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Normal frequency of the passages stools and an infant
Around 6 to 8 times daily which is about one stool per breast-feeding
On the fourth week of life the store frequency changes. The stool frequency decreases to one or two episodes daily or even less such as three episodes per week
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Presentation of Hirschsprungs disease
Salyer to pass meconium in the first 48 hours of life
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Presentation of pyloric stenosis
Post prandial, non-bilious, and often projectile vomit Ing that present at the age of 3 to 6 weeks
Usually do not present with diarrhea or constipation
68
Next step in a patient with iron deficiency anemia and positive FOBT
Colonoscopy
If colonoscopy is on remarkable, upper gastrointestinal endoscopy should be performed
69
Chest pain associated with GERD
Uncomfortable squeezing or burning sensation in the retrosternal chest that radiates toward the back, neck, jaws, or arms
The pain may resolve spontaneously or after consumption of ant acids
Pain usually occurs postprandially
Pain can awaken the patient from sleep and sometimes worsens with emotional stress
70
Pain on an empty stomach
How many reported and patients with duodenal ulcer's
71
Screening for celiac disease
Anti-endomysial anti-body and tissue transglutaminase anti-body
Checking both increases the sensitivity for diagnosing the disease
72
Gold standard for diagnosing celiac disease
Small intestinal biopsy
73
Deficiencies in celiac disease
Iron deficiency anemia and vitamin D deficiency
74
Treatment of dumping syndrome
High-protein diet and low carbohydrate diet
Smaller but more frequent meals throughout the day
75
Associations with angiodysplasia
Aortic stenosis
End stage renal disease
76
Presentation of a cute radiation proctitis
Diarrhea, mucus discharge, and tenesmus during or within six weeks of pelvic radiation
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Presentation of chronic radiation proctitis
Present similarly to a cute radiation proctitis but after nine weeks two years after radiation therapy
More commonly associated with strictures, fistula formation, and rectal bleeding
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Diagnosis of radiation proctitis
Made after excluding other causes of colitis
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Treatment of acute radiation proctitis
Supportive measures such as fluids and anti-diarrheal medications
80
Treatment of chronic radiation proctitis
May require sucralfate or glucocorticoid enemas
81
Presentation of acute ischemic colitis
Abdominal pain followed by bloody diarrhea
82
Most vulnerable areas for acute ischemic colitis
The watershed areas such as the splenic flexure are in the rectosigmoid junction
83
Position to prevent aspiration pneumonia
Upright supine
84
Presentation of diabetic Gastro paresis
Early satiety and post prandial fullness
Labile glucose control
85
Diagnosis of diabetic gastroparesis
Must first rule out mechanical obstruction with upper endoscopy
Confirm diagnosis with gastric emptying study
86
Treatment of diabetic gastroparesis
Dietary modification with frequent smaller meals
Erythromycin or metoclopramide maybe you needed if dietary changes are insufficient
87
Vaccine needed in patients with hepatitis C
Hepatitis A vaccine
88
Presentation of infantile hypertrophic pyloric stenosis
Male infant age 3 to 6 weeks who develops postprandial projectile vomiting
Usually no blood or bile in the vomit
Child is immediately hungry after vomiting
89
Physical exam in infants with hypertrophic pyloric stenosis
Olive shaped mass in the right upper quadrant of the abdomen
90
Diagnosis of infantile hypertrophic pyloric stenosis
Ultrasound
91
Diagnosis of intussusception
Barium enema
92
Medication associated with infantile hypertrophic pyloric stenosis
Erythromycin
93
Diagnosis of toxic megacolon
Abdominal plain films
94
Treatment of toxic megacolon
Treat the underlying condition
Glucocorticoids for patients with inflammatory bowel disease
Appropriate anabiotic's for patients with C. difficile infection
95
Definition of dyspepsia
Greater than one of the following symptoms
Postprandial fullness
Epigastric pain or burning
Early satiety
96
Dyspepsia inpatients greater than 55 with alarm features
Should undergo upper endoscopy
97
Treatment of fecal impaction
Enemas followed by suppositories
Once complete everything has been achieved, the patient is instructed to increase his fiber and fluid intake
98
Providing nutrition two patients with Oro pharyngeal dysphasia following stroke
Gastrostomy tube placement is an option in patients who are unable to tolerate PO intake
99
Charcots triad
Fever
Jaundice
Right upper quadrant pain
100
Raynolds pentad
Fever
Jaundice
Right upper quadrant pain
Hypotension
Confusion
101
Treatment of Malory Weiss tear in patients who are not actively bleeding
Observation and supportive care
102
Anatomical predisposing factor for Malory Weiss tear
Hiatal hernia
103
Isolated gastric varices
Likely a complication of chronic recurrent pancreatitis leading to splenic vein thrombosis
104
First-line therapy for hyperbilirubinemia in neonates
Phototherapy which converts bilirubin into a water-soluble form that can be excreted more easily
105
Diagnosis of chronic pancreatitis
Abdominal CT scan
Pancreatic calcifications
Pancreatic enlargement
Ductal dilation
Pseudocysts
106
Treatment of chronic pancreatitis
Cessation of alcohol intake and diet consisting of smaller meals
Pancreatic enzyme replacement and possible opiate medications are the next treatment if conservative measures do not work
107
Time it takes for full-time infant to pass meconium
Within 48 hours of birth
108
Initial test in infants who do not pass meconium within the first 48 hours
Abdominal x-ray
The presence of multiple dilated bowel loops and the absence of rectal air are concerning for distal bowel obstruction
Followed by contrast enema
109
Hirschsprung's disease confirmation
Rectal mucosal suction biopsy
Shows the absence of gangly on cells
110
Treatment of Hirschsprung's disease
Surgical resection of the aganglionic segment followed by anastomosis
111
Diagnosis of acute pancreatitis
Confirmed with an elevated serum amylase or lipase in the setting of acute upper abdominal pain radiating to the back
112
Antibiotics and acute pancreatitis
Indicated only in patients with clinical or tissue evidence of infection or necrotic pancreatic tissue
Not indicated and patient with mild attacks of acute pancreatitis
113
Next step in patients with acute pancreatitis who have signs of deterioration or infection after 72 hours
CT scan of the abdomen
114
MELD
Model for end stage liver disease
115
Purpose of MELD
Used to determine allocation of liver transplants and whether or not TIPS should be performed
116
Components of MELD score
Bilirubin
INR
Creatinine which is the worst prognostic indicator
117
Bile salts induced diarrhea
Occurs in some patients after cholecystectomy and in patients with short bowel syndrome
Treatment of choice is cholestyramine
118
Presentation of mesenteric ischemia
Acute onset severe abdominal pain with unremarkable physical exam along with metabolic acidosis
119
Most common cause of mesenteric ischemia
Occlusion of the superior mesenteric artery by embolism
120
Complications of acute mesenteric ischemia
Bowel infarction
Sepsis
Death
121
Diagnosis of acute cholecystitis
Abdominal ultrasound
122
Suspected acute cholecystitis with an unremarkable ultrasound
Order HIDA scan
Positive if the gallbladder does not visualize usually from cystic duct obstruction due to gallstones or gallbladder Edema
123
Proton pump inhibitor or side effect on bones
Increases the risk of osteoporosis and hip fracture
Decreased calcium absorption, inhibit osteoclast activity
And eventually reduce bone mineral density
124
Presentation of Meckel's diverticulum
Two-year-old with painless hematochezia
Bleeding is due to mucosal irritation from gastric acid
Intussusception, volvulus
125
Meckel's diverticulum pathophysiology
Failure of the vitelline duct to obliterate during the first eight weeks of gestation, leaving behind a blind pouch often containing ectopic gastric tissue
126
Diagnosis of Meckel's diverticulum
Technetium 99 nuclear scan
Usually located in the right lower quadrant within 2 feet of the ileocecal valve
127
Treatment of Meckel's diverticulum
Surgery
128
Most common source of diverticular bleeding
Erosion of the artery
129
Type of cancer associated with celiac disease
Intestinal lymphoma
130
Presentation of intestinal lymphoma
Abdominal pain, weight loss, diarrhea, despite adherence to a gluten-free diet
131
Initial testing for patients with chronic diarrhea
Micro scopic examination of the stool
132
Diagnosis of celiac disease
Small intestinal biopsy
Will show mucosal flattening and a lymphocytic infiltration
133
Treatment of celiac disease
Gluten-free diet
May need vitamin replacement
134
Management of partial small bowel obstruction
Initially with conservative therapy
If failed to improve within the next 12 to 24 hours will need surgical intervention
135
Common causes of hepatic encephalopathy he
G.I. bleeding
Hypokalemia
Hypovolemia
Infection
136
Treatment of porcelain gallbladder
Cholecystectomy
137
Presentation of SIBO
Abdominal bloating, flatulence, diarrhea
138
Diagnosis of small intestinal bacterial overgrowth
Endoscopy with jejunal aspirate showing greater than 10 organisms is the gold standard
139
Screening for celiac disease
IGA tissue transglutaminase anti-body
140
Treatment of H pylori infection
Triple drug therapy with a PPI, clarithromycin, and amoxicillin
Metronidazole in case of penicillin allergy
141
Cancer associated with H pylori
Gastric cancer
M AL T lymphoma
142
Treatment of persistent H pylori
Quadruple therapy using a PPI, bismuth, tetracycline, and metronidazole
143
Follow up testing to confirm H pylori infection eradication
Urea breath test or stool antigen testing for to six weeks after treatment completion
144
Presentation of esophageal perforation
Acute chest pain following episodes of vomiting
145
Pathophysiology of esophageal perforation
Most tears occur in the distal third of the esophagus, which leads to pleural effusion
146
Diagnosis of esophageal perforation
Water-soluble esophagram
147
Management of acute Cholangitis
Blood cultures followed by anabiotic's, hydration, and close monitoring
If patient clinically improved, elective ERCP should be scheduled
If conservative therapy fails, urgent biliary decompression is warranted with emergent ERCP
148
Surveillance endoscopy following treatment for ulcers
Needed for gastric ulcers which have higher risk of malignancy
Not needed for duodenal ulcer's
149
Positive fecal occult blood test
Colonoscopy
150
Screening for Barrett's esophagus
Barrett's esophagus and no dysplasia requires endoscopy every 3 to 5 years
Low-grade dysplasia requires endoscopy every 6 to 12 months
High-grade dysplasia requires endoscopic eradication therapy
151
Most common cause of hospital acquired diarrhea
Clostridium difficile
152
Treatment of hospital acquired diarrhea in patients who have negative clostridium difficile PCR
Anti-motility agents such as a loperamide
