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my NPLEX II > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

acute pancreatitis labs and imaging

A
  • inc serum amylase/lipase
  • **ALT > 150 biliary pancreatitis

IMAGING:

  • **CT with IV contrast
  • Xray shows sentinel loop (dilation segment) with no peristalsis (caused by inflammation of pancreas)
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2
Q

Cullen’s sign

A
  • periumbilical hemorrhage visible as a bruise under umbilicus (acute pancreatitis)
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3
Q

Grey-Turner sign

A

flank hemorrhage - looks like bruise in flank region (acute pancreatitis)

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4
Q

chronic pancreatitis labs/imaging

A
  • CT, US and XRay shows calcification; CT and US also show dilated pancreatic ducts and pseudocyst
  • Inc serum ALP, serum glucose,
  • Amyase and lipase will either be increased or normal
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5
Q

peritonitis labs/imaging

A
  • plain films of abdomen
  • peritoneal fluid analysis (examine neutrophil count)
  • tests to r/o other causes (Liver fxn, CBC, Abd US, UA)
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6
Q

most common cause of death from portal HTN/liver cirrhosis

A

rupture of esophageal varices

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7
Q

most common type of hiatal hernia

A

sliding

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8
Q

in sliding hernia, where is the gastroesophageal junction

A

above the diaphragmatic esophageal hiatus

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9
Q

imaging for hiatal hernia

A
  • barium swallow, endoscopy, esophageal manometry (procedure for measuring LES pressure)
  • gastroscopy with biopsy (to r/o barrett’s esophagitis and cancer)
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10
Q

Esophageal carcinoma m/c in males or females?

A

males, common cause of cancer death

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11
Q

Risk factors of Squamous Cell Carcinoma Esophageal Carcinoma

A

4S’s: Smoking, Spirits (alcohol), Seeds (betel nut), Scalding hot liquids

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12
Q

Imaging for esophageal cancer

A
  • barium swallow (very sensitive for detecting masses but NOT diagnostic)
  • Esophagoscopy (visualize and biopsy)
  • Endoscopic US - MOST SENSITIVE for depth of tumor (T staging) and can see presence of LN (N staging)
  • CT scan (look at local disease and for metastases)
  • bronchoscopy (for middle and upper 1/3 of esophagus, can help exclude invasion of trachea)
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13
Q

PUD diagnosis

A
  • Endoscopy (95% accurate)
  • must biopsy gastric ulcers (to check for cancer), but not duodenal
  • Urea breath test
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14
Q

most common gastric carcinoma

A

adenocarcinoma

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15
Q

most common age group gastric carcinoma

A

50-59 yo

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16
Q

common mets from gastric cancer

A

liver, lung, brain

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17
Q

imaging gastric carcinoma

A
  • esophagogastro-duodenoscopy & biopsy

- CT chest/abdomen/pelvis

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18
Q

ALT > AST could indicate

A

viral hepatitis (ALT elevated in fatty liver)

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19
Q

AST > ALT

A

alcoholic hepatitis

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20
Q

If ALP&raquo_space;» ALT, rule out what?

A

bone disease

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21
Q

ALP and GGT increased indicates

A

liver cholestasis or hepatocellular carcinoma

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22
Q

Conjugated bilirubin (CB) < 20%

A

unconjugated hyperbilirubinemia (extravascular hemolytic anemia)

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23
Q

CB 20-50%

A

mixed hyperbilirubinemia (viral hepatitis)

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24
Q

CB > 50%

A

conjugated hyperbilirubinemia (liver cholestasis)

25
Q

low serum albumin

A

hypoalbuminemia = severe liver disease

26
Q

increased prothrombin time (PT)

A
  • hepatic protein synthesis impairment
  • liver cirrhosis
  • vitamin K deficiency
27
Q

Decreased BUN

A

liver cirrhosis

28
Q

increased Serum ammonia

A
  • cirrhosis

- reyes syndrome

29
Q

alpha-fetoprotein (AFP) is a marker for

A

hepatocellular carcinoma

30
Q

Viral hepatitis prodrome symptoms

A

fever, painful hepatomegaly, dislike of alcohol and cigarettes, serum transaminase increase and peaks

31
Q

viral hepatitis labs when Pt has jaundice

A
  • increased urine bilirubin and urine urobilinogen

- ALT > AST

32
Q

What lab shows active hep A infection

A

Anti-HAV- IgM

33
Q

Hep B surface antigen (HBsAG) appears when

A

2-8 weeks after exposure

34
Q

HBsAG persists how long

A

5-6months

35
Q

What remains + during acute infections and is non-protective?

A

Anti-HBV core antigbody IgM

36
Q

What is a protective antibody and marker of HBV vaccine

A

Anti-HBV surface antibody (Anti-HBs)

37
Q

Hepatocellular Carcinoma Risk Factors

A
  • OCPs (3x inc risk), steroids
  • alcoholic cirrhosis
  • chronic hep B and C
  • Aspergillus mold (aflotoxin) in grains and peanuts
38
Q

tumor marker for gall bladder adenocarcinoma

A

CA 19-9

39
Q

gall bladder adenocarcinoma labs

A
  • increased alkaline phosphatase (ALP) and bilirubin levels
  • CBC showing anemia
  • US mass in RUQ
40
Q

appendicitis labs/imaging

A
  • neutrophilic leukocytosis (left shift)
  • high leukocyte count with perforation
  • B-hCG to rule out ectopic preg
  • AbN urinalysis (inc protein, hematuria, pyuria)
  • US, CT scan
41
Q

imaging for inflammatory diarrhea

A

flexible sigmoidoscopy

42
Q

Celiac labs

A
  • high anti-tissue transglutaminase Abs OR anti-endomysium antibodies
43
Q

diverticulosis imaging

A

plain abdominal x-ray may shown thick wall, small bowel obstruction, or free air if perforation but are INSUFFICIENT for diagnosis

  • Constrast CT is best
  • Colonoscopy 4-6 weeks after acute episode
44
Q

Crohn’s labs/imaging

A
  • endoscopy with biopsy for diagnosis
  • barium, CT abdomen (cobblestone appearance)
  • CRP
45
Q

M/C location of Crohn’s

A

ileum and ascending colon

46
Q

are fistulas, obstruction and colon cancer more common in UC or Crohn’s?

A

UC

47
Q

smoking is a RF for Crohn’s or UC?

A

Crohn’s

48
Q

smoking is protective for Crohn’s or UC?

A

UC

49
Q

Crohn’s onset and peak what ages?

A

onset before 30yo, peak age 60

50
Q

What condition has lead pipe on Xray with barium enema?

A

UC

51
Q

diagnosis of UC through what imaging

A
  • sigmoidoscopy with biopsy usually sufficient

- stool culture, microscopy, and C.diff toxin assay is necessary to rule out infection

52
Q

complications of UC

A
  • toxic megacolon

- adenocarcinoma

53
Q

Rome III Criteria for Dx of IBS

A

at least 12 weeks in past 12 months of at least 2 of these:

  1. relieved with defecation
  2. onset with change in Frequency of stool
  3. onset with change in FORM of stool
54
Q

Meckel Diverticulum imaging

A

technetium-99 radioisotope scan to identify ectopic gastric mucosa

55
Q

toxic megacolon etiology

A
  • IBS (UC > Crohn’s)

- infectious colitis (bacterial, viral, parasitic)

56
Q

toxic megacolon diagnostic criteria

A

must have 3 of these:

  1. heart rate > 120 bpm
  2. fever > 101.5
  3. leukocytosis
  4. anemia
  5. one of these: dehydration, electrolyte abnormalities, altered mental status, hypotension
57
Q

toxic megacolon labs/imaging

A
  • leukocytosis w/ left shift
  • CBC - anemia (from bloody diarrhea)
  • abdominal x-ray (dilated colon & loss of haustra)
  • CT may show perforation
58
Q

Colon cancer tumor markers

A

carcinoembryonic antigen (CEA)

59
Q

imaging for Colorectal Cancer to determine T and N stage

A

MRI or endorectal US

my NPLEX II (28 decks)

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