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Internal Medicine Mnemonics > Gastroenterology > Flashcards

Flashcards in Gastroenterology Deck (200):
1

Gastrin

Secreted by G-cells (antrum), stimulates parietal cells in fundus

2

Cholecystokinin

Secreted by I-cells (duodenum), contracts gallbladder and plrolongs gastric emptying time

3

Secretin

Secreted by S cells (duodenum), inhibits acid secretion

4

Glucose-dependent Insulinotropic Peptide

Secreted by K cells (duodenum), stimulates insulin secretion

5

Gastrin, Histamine, Acetylcholine

Stimulate gastric acid secretion (synergistic effect)

6

Motilin

Stimulates motility during fasting

7

Mucus Neck Cells

Secretes mucus in the stomach

8

Parietal Cells

Secretes HCl and intrinsic factor in the stomach

9

Chief Cells

Secretes pepsinogen in the stomach

10

Enterochromaffin cells

Secretes serotonin in the stomach

11

Enterochromaffin-like cells

Secretes histamine in the stomach

12

Interstitial cells of Cajal

Pacemaker cells of the GI that generates slow waves

13

Liver Acinus Model (Zones 1-3)

Preferred functional unit of the liver

14

Ito Cells

Stores Vitamin A in the liver

15

Enterokinase

Intestinal enzyme that triggers conversion of pancreatic trypsinogen to trypsin

16

Enterohepatic circulation

Main mechanism for bile salt reabsorption

17

Triglyceride Absorption

Lumer -> intestinal cells as micelles --> lacteals as chylomicrons

18

Mouth (salivary amylase/ptyalin)

Initial digestion of carbohydrates

19

Stomach (lingual lipase)

Initial digestion of fats

20

Stomach (pepsin and HCl denaturation)

Initial digestion of proteins

21

Duodenum

For iron and vitamin C absorption

22

Jejunum

Main site for Carbohydrates, fats, proteins, water absorption

23

Ileum

Main site for vitamin B12, IF, bile salts and vitamins ADEK absorption

24

Rule of 2's in Meckel's diverticulum

2% of population, 2 years old, 2:1 male to female ratio, 2 tissue types involved, 2 inches long, 2 feet from Ileocecal valve

25

Diagnostic Criteria for Irritable Bowel Syndrome

Recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months associated with 2 or more of the following: improvement with defecations, onset associated with a change in frequency of stool, onset associated with a change in appearance of stool

26

Charcot's Triad for Ascending Cholangitis

Fever, Abdominal Pain, Jaundice

27

Charcot's Triad for Multiple Sclerosis

Scanning speech, intention tremor, nystagmus

28

Reynold's Pentad

Charcot's Cholangitis Triad + Shock and confusion

29

Triad of Hepatopulmonary Syndrome

Liver disease, Hypoxemia, Pulmonary arteriovenous shunting

30

Triad of Acute Cholecystitis

Sudden RUQ tenderness, fever, leukocytosis

31

Triad of Choledochal Cyst

Abdominal pain, jaundice, abdominal mass

32

Triad of Hemobilia

Biliary Pain, Obstructive Jaundice, Melena

33

Diagnosis of Acute Pancreatitis

Typical abdominal pain, 3x or grater elevation in serum amylase and/or lipase levels, Confirmatory findings on cross-sectional abdominal imaging

34

Pseudocyst

Increase in size of the mass, a localized bruit over the mass, sudden decrease in hemoglobin and hematocrit without external blood loss

35

Classic Symptoms of GERD

Water brash and substernal heart burn

36

Gastroesophageal reflux

Most common cause of esophageal chest pain

37

24-hour ambulatory pH monitoring

Most sensitive test for diagnosis of GERD

38

Globus hystericus

Perception of a lump or fullness in the throat that is felt irrespective of swallowing

39

Odynophagia

Characteristic symptom of infectious esophagitis

40

Schatzki ring in the lower esophagus

Common cause of steakhouse syndrome

41

Bird's beak appearance

Radiographic sign in achalasia

42

Corkscrew or rosary bead esophagus

Seen radiographically in diffuse esophageal spasm or spastic achalasia

43

Esophageal manometry

Detects impaired LES relaxation and absent peristalsis in achalasia

44

Endoscopy or esophagogastroduodenoscopy

Best test for evaluation of proximal GIT

45

Crohn's disease

Cobblestone appearance of esophagus

46

Endoscopic biopsy

Gold standard for confirmation of Barrett's esophagus

47

Typical presentation of esophageal cancer

Progressive solid food dysphagia and weight loss

48

Squamous cell CA

Middle third of the esophagus, associated with smoking

49

Adenocarcinoma

Distal third of the esophagus, associated with GERD and Barrett's esophagus (metaplasia from squamous to columnar epithelium)

50

Peptic ulcers

Most common cause of UGIB

51

Hemorrhoids

Most common cause of LGIB overall

52

Anal fissure

Most common cause of rectal bleeding during infancy

53

Meckel's diverticulum

Most common cause of significant LGIB in children

54

BD and juvenile polyps

Most common colonic causes of significant GIB in children and adolescents

55

Hemorrhage from a colonic diverticulum

Most common cause of hematochezia in the elderly

56

Small intestinal sources of bleeding

Majority of obscure GIB

57

Boerhaave Syndrome

Full-thickness esophageal tear

58

Mallory-Weiss Tear

Partial-thickness esophageal tear

59

Classic history of Mallory-Weiss Tear

Vomiting, retching, coughing, hematemesis in an alcoholic/bulimic patient

60

NSAID, alcohol, stress

Most important causes of Hemorrhagic and erosive gastropathy

61

Heart rate and BP

Best way to initially assess a person with GIB

62

Upper endoscopy

Procedure of choice in UGIB

63

Colonoscopy after an oral lavage solution

Procedure of choice in LGIB

64

Angiography

Initial test for massive obscure GIB

65

Key enzyme in rate-limiting step of prostaglandin synthesis

Cyclooxygenase

66

Most common causes of gastric/duodenal ulcers

H. pylori and NSAU+Iss

67

Most common location of GU's

1st portion of duodenum

68

Most discrimating symptom of Dus

Pain that awakens the patient from sleep

69

Most frequent finding in patients with GU/DU

Epigastric tenderness

70

PUD-related complications

GI bleeding > perforation > gastric outlet obstruction (in order of decreasing frequency)

71

Most potent acid inhibitory agents

Proton pump inhibitors

72

Most common toxicity with sucralfate

Constipation

73

Most common toxicity with prostaglandin analogs

Diarrhea

74

Most feared complication with amoxicillin, clindamycin

Pseudomembranous colitis

75

GU: failure to heal after 12 weeks of therapy, DU: failure to heal after 8 weeks of therapy

Refractory Peptic Ulcers

76

Most common cause of treatment failure in compliant patients

Antibiotic-resistant H. pylor strains

77

Test of choice for documenting eradication of H. pylori

Urea breath test

78

Most commonly performed operations for DU's

Vagotomy and drainage, highly selective vagotomy, vagotomy with antrectomy

79

High ulcer recurrence rate but lowest complication rate

Highly selective vagotomy

80

Lowest ulcer recurrence rate but highest complication rate

Vagotomy with antrectomy

81

Surgery of choice for an antral ulcer

Antrectomy (including ulcer) with a Billroth I anastomosis

82

Cornerstone therapy for dumping syndrome

Dietary modification

83

Severe peptic ulcer diathesis secondary to gastric acid hypersecretion due to unregulated gastrin release from gastrinomas

Zollinger-Ellison Syndrome

84

Most common location of gastrinomas

Pancreas >> duodenum

85

Gastrinoma triangle (contains over 80% of these tumors)

Superior border: cystic and common bile duct; Inferior border: junction of the 2nd and 3rd portions of duodenum; Medial border: junction of the neck and body of the pancreas

86

Most common clinical manifestation of gastrinoma

Peptic ulcer followed by diarrhea

87

Most sensitive/specific Gastrin Provocative Test

Secretin study

88

Treatment of choice for Gastrinoma

PPIs

89

Most common presentation of Stress-Related Mucosal Injury

GI bleeding

90

Treatment of choice for stress prophylaxis

PPIs (preferably oral, if tolerated)

91

Most common cause of acute gastritis

Infectious

92

Important predisposing factor for gastric cancer

Intestinal metaplasia

93

Involves primarily the fundus and body with antal sparing. It is the less common type

Type A gastritis (Autoimmune: anti-parietal cell antibodies)

94

Antral predominant. The more common type

Type B gastritis (Bacteria: H. pylori-associated)

95

Large, tortuous gastric mucosal folds (not a form of gastritis)

Menetrier's disease

96

Ulcerative Colitis

Mucosal disease that usually involves the rectum and extends proximally to involve all or part of the colon

97

Crohn's disease

Can affect any part of the GIT from mouth to anus but rectum is often spared

98

Toxic megacolon

Transverse or right colon with diameter of >6cm and loss of haustrations in severe attacks of UC

99

pANCA Positivity (perinuclear anti-neutrophil Cytoplasmic antibodies)

UC >> CD

100

ASCA positivity (Anti-Saccharomyces cerevisiae antibodies)

CD >> UC

101

Fecal lactoferrin and calprotectin

Markers of intestinal inflammation

102

Appendectomy

Protective against UC, increased risk for CD

103

Aphthoid ulcerations and focal crypt abscesses

Earliest lesion in CD

104

Granulomas

Pathognomonic feature of CD

105

Terminal ileum

Most common site of inflammation in CD

106

Fine mucosal granularity

Earliest radiologic change of UC seen on barium enema

107

Perforation

Most dangerous local complication of UC

108

Conjunctivitis, anterior uveitis/iritis and episcleritis

Most common ocular complications of IBD

109

Calculi, ureteral obstruction and fistulas

Most common genitourinary complications of IBD

110

Sulfazaline and other 5-ASA afaents

Mainstay of therapy for mild to moderate UC and Crohn's colitis

111

Glucocorticoids (no role as maintenance therapy)

Treatment of moderate to sever IBD

112

Infiximab (TNF-alpha antibody)

First biologic therapy approved for CD

113

Ileal Pouch Anal Anastomosis

Operation of choice for UC

114

Pouchitis

Most frequent late complication of IPAA

115

Abdominal pain or discomfort

Key symptom/prerequisite clinical feature for the diagnosis of IBS

116

Altered bowel habits (most commonly constipation alternating with diarrhea)

Most consistent clinical feature in IBS

117

Evidence of anemia, elevated sedimentation rate, presence of leukocytes or blood in stool, stool volume > 200-300 mL/day

Laboratory features that argue against IBS

118

Antispasmodics 30 minutes before meals

Best management for postprandial pain

119

Peripherally-acting opiate-based agents

Initial theapy of choice for IBS-D (diarrhea predominant)

120

Rifaximin

Only antibiotic for IBS with sustained benefit beyoin therapy cessation

121

True diverticulum

Saclike herniation of the entire bowel wall

122

False diverticulum

Only a protrusion of the mucosa through the muscularis propria of the colon (where the vasa recti penetrates)

123

Diverticulitis

Inflammation of the diverticulum

124

Giant diverticulum of the sigmoid colon

Air-fluid level in the LLQ on plain abdominal film

125

Hinchey Classification System

Staging system for predicting outcomes after surgery for perforated diverticulitis

126

Sigmoid diverticula, thickened colonic wall > 4 mm, Inflammation within the pericolic fat with or without collection of contrast material or fluid

Diagnosis of diverticulitis is best made with these findings

127

6 weeks after an attack of diverticular disease (should not be performed in acute setting due to higher risk of infection)

Safety window for barium enema or colonoscopy

128

Angiography with or without coiling (if patient unstable or has had a 6-unit bleed within 24 hours, emergent surgery should be performed)

Best management for massive diverticular bleeding in a stable patient

129

Diet alterations

best management for asymptomatic diverticular disease

130

Antibiotics and bowel rest

Initial treatment for symptomatic uncomplicated diverticular disease

131

Procidentia

Circumferential, full-thickness protrusion of the rectal wall through the anal orifice

132

Fecal incontinence

Involuntary passage of fecal material > 10 mL for at least 1 month

133

Anismus

The result of attempting to defecate against a closed pelvic floor (aka non relaxing puborectalis)

134

Mucosal vs. Full Thickness rectal prolapse

Radial vs. circumferential grooves around anus

135

Surgical correction

Mainstay of Therapy for rectal prolapse

136

Left lateral, right anterior, right posterior

3 hemorrhoidal complexes in the anal canal

137

Bleeding and/or protrusion

Most common presentation of hemorrhoids

138

Perianal pain and fever

Hallmarks of anorectal abscess

139

Perianal, followed by ischiorectal

Most common location of anorectal abscess

140

Posterior position, followed by anterior (lateral fissure is worrisome and systemic disorders should be ruled out)

Most common location of anal fissures

141

Dentate line

Most common location of Internal Opening of Fistula in Ano (FIA)

142

Intersphincteric, followed by transsphincteric

Most common type of FIA

143

Goodsall's Rule for FIA

Anterior fistula: straight tract to nearest crypt, Posterior fistula: curved tract to enter anal canal at posterior midline. Exception: fistulas exiting a >3cm from the anal verge may not obey Goodsall's rule

144

Seton (vessel loop or silk tie placed through the tract)

Best management for newly-diagnosed FIA

145

Strangulated small bowel obstruction followed by ischemic colitis

Most common form of acute intestinal ischemia

146

Ischemic colitis

Most prevalent gastrointestinal disease complicating cardiovascular surgery

147

Griffith's point: splenic flexure and Sudeck's point: descending sigmoid colon

Most common locations for Colonic Ischemia

148

Laparotomy

Gold standard for diagnosis and management of Acute Arterial Occlusive Disease

149

Mesenteric angiography

Gold standard for confirmation of mesenteric arterial occlusion in chronic intestinal ischemia

150

Fluid resuscitation

Intervention of choice to maintain hemodynamics in nonocclusive/vasospastic mesenteric ischemia

151

Resection of ischemic bowel and formation of proximal stoma

Optimal treatment for ischemic colitis

152

Timeliness of diagnosis and treatment

Most significant indicator of survival in mesenteric ischemia

153

Mesenteric venous insufficiency

Best prognosis of all acute intestinal ischemic disorders

154

Area of immunofluorescence > 5 mm in diameter under UV illumination with Woods lamp

Marker of intestinal nonviability

155

Adynamic ileus, primary intestinal pseudo-obstruction

Main differentials for acute intestinal obstruction

156

Adhesions

Most common cause of small-intestinal obstruction

157

Colon cancer

Most common cause of intestinal obstruction

158

Hydrochloric acid, colonic contents, pancreatic enzymes

Most irritating substances to the peritoneum

159

Abdominal distention (more prominent in more distal sites of obstruction)

Hallmark of all forms of intestinal obstruction

160

Fluid and gas-filled loops of small intestine, stepladder pattern with air-fluid levels, absence of paucity of colonic gas

Pathognomonic signs for small bowel obstruction on plain abdominal film

161

Abdominal CT (can differentiate between adynamic ileus, partial obstruction and complete obstruction)

Most commonly used modality to evaluate postoperative patients for intestinal obstruction

162

>10 cm on plain abdominal film

Cecal diameter that increases likelihood of perforation

163

Closed loop: lumen is occluded at two points by a single mechanism (such as fascial hernia or adhesive band) also often with occlusion of blood supply, leading to high pressures and gangrene

Most feared complication of acute intestinal obstruction

164

Appendicitis

Most common abdominal surgical emergency

165

Fecalith

Most common cause of appendiceal luminal obstruction leading to acute appendicitis (AA)

166

Sequence of abdominal discomfort and anorexia

Pathognomonic in AA

167

Urinalysis

Most useful test in excluding genitourinary conditions that may mimic AA

168

Appendicitis

Most common extrauterine condition requiring abdominal operation during pregnancy

169

Second trimester

Most common period of occurrence of AA during pregnancy

170

Ultrasound

Best diagnostic exam for AA during pregnancy

171

Acute abdominal pain and tenderness, usually with fever

Cardinal manifestations of peritonitis

172

Uncomplicated appendicitis and diverticulitis

Most common causes of localized peritonitis

173

Hepatocellular pattern of liver disease

Liver injury, inflammation and necrosis predominate

174

Cholestatic pattern of liver disease

Inhibition of bile flow predominates

175

Grading of liver disease

Histologic assessment of necroinflammatory activity: acute or chronic; active or inactive; mild, moderate or severe

176

Staging of liver disease

Level of progression of the disease, based on the degree of hepatic fibrosis: early or advanced, precirrhotic or cirrhotic

177

Criterion standard in evaluation of liver disease and most accurate means of assessing grade and stage

Liver biopsy

178

Prognostication for cirrhosis and provides standard criteria for listing for liver transplantation (Class B and C); utilizes serum bilirubin, serum albumin, PT-INR and severity of ascites and hepatic encephalopathy

Child-Pugh Score

179

More objective means of assessing disease severity; utilizes serum bilirubin, serum creatinine and PT-INR

Model for End-Stage Liver Disease Score

180

Indicates cirrhosis with Child-Pugh score of greater than or equal to 7 (Class B or C)

Liver decompensation

181

Occurrence of signs or symptoms of hepatic encephalopathy in a person with sever acute or chronic liver disease

Hepatic failure

182

Hepatic inflammation and necrosis that continue for at least 6 months

Chronic hepatitis

183

Most common and most characteristic symptom of liver disease

Fatigue

184

Hallmark of liver disease and most reliable marker of severity

Jaundice

185

Most reliable physical finding in examining the liver

Hepatic tenderness

186

Best physical exam maneuver to appreciate ascites

Shifting dullness on percussion

187

Major criterion for diagnosis of fulminant hepatitis

Hepatic encephalopathy during acute hepatitis (indicates poos prognosis)

188

Screening test for hepatopulmonar syndrome

Oxygen saturation by pulse oximetry

189

Most commonly used liver function test

Serum bilirubin, serum albumin, prothrombin time (PT)

190

Rate-limiting step in bilirubin metabolism

Transport of conjugated bilirubin into the bile canaliculi (not conjugation itself)

191

Any bilirubin found in the urine is in the form of

Conjugated/Direct Bilirubin

192

Exclusive sites for the synthesis of serum albumin

Hepatocytes

193

Only clotting factor not produced in the liver

Factor VIII

194

Single best acute measure of hepatic synthetic function

Protime (PT) (PT prolongation of > 5 secs not corrected by parenteral vitamin K administration is poor prognostic sign in acute viral hepatitis)

195

Most helpful in recognizing Acute Hepatocellular Disease

Elevated aminotransferases/transaminases

196

Differentials for striking elevations in aminotransferases (>1000 U/L)

Viral hepatitis, Ischemic liver injury, Toxin- or drug-induced liver injury, acute phase of biliary obstruction caused by passage of gallstone in the CBD

197

AST>ALT

Alcoholic liver disease

198

ALT>AST

Viral hepatitis

199

Key events in hepatic fibrogenesis

Stellate cell activation and collagen production

200

First indication of worsening hepatic fibrosis

Mild thrombocytopenia