Flashcards in Gastrointestinal Deck (114):
Term for difficulty swallowing
Bird beak esophagus on barium swallow should make you think of what dx
What is the most common location for an anal fissure?
Crohn's disease is found where in the GI tract?
It can be from the esophagus to the anus
What does HBsAg (hep B surface antigen) indicate?
Active hep B infection
How do you treat achalasia?
Loosen up the muscle--Botox, dilation or surgery
A corkscrew appearance on barium study should make you think of what dx?
Epigastric abdominal pain which radiates to the back should make you think of what dx?
IOT contract hepatitis D what must you already have?
Left lower quadrant pain and tenderness should make you think of what dx?
What is the treatment for most Mallory-Weiss tears?
Watchful waiting, these will typically resolve within 48 hours
A thumbprint sign on an abdominal film should make you think of what dx?
What will the bowel sounds be early on in a small bowel obstruction? What will they be later on?
Early they are hyperactive. Late they are absent.
A pt has had GERD for yrs. over the past year, he has noticed an increase in difficulty swallowing his food. This should make you think of what dx?
What are two tx you should consider for esophageal strictures?
Dilation of the esophagus and long term PPIs
What are 2 common predisposing factors for esophageal varices?
Portal HTN and cirrhosis often caused by alcoholism
What is a common symptom that goes along with chest pain for GERD pts?
What medication is most commonly used for long term treatment of GERD?
Proton pump inhibitors
What is the imaging modality of choice for pancreatitis?
What is the best test to check for H. Pylori?
Urea breath test
Is peptic ulcer disease more common in the duodenum or the stomach?
What is the most common location for a pancreatic tumor?
75% occur in the head of the pancreas
With a gastric ulcer are the patient's symptoms exacerbated or relieved with food?
Projectile vomiting should make you think of what dx?
Most gallstones are made of what substance?
What is the name of the sign when a pt shows inhibited inspiration with pressure over the RUQ? What dx does it suggest?
What is the most specific test for acute cholecystitis?
What is the gold standard for dx of and tx of bile duct stones?
What is Charcot's triad?
What is Reynold's Pentad and why does it matter?
Charcot's triad plus
Altered mental status
It indicates sepsis and is endoscopic emergency
What diseas is defined as an immunologic response to gluten?
What is the main risk factor for esophagitis?
An endoscopy for presumed ulcers shows multiple shallow ulcers. What is the most likely dx?
Herpes simplex virus
List 2 common offending agents for pill induced esophagitis?
NSAIDS, KCl, iron, antibiotics
A 30 yr old AA woman presents with dysphagia. You notice she also has thickened skin. A barium swallow demonstrates the absence of peristalsis. What is the most likely dx?
What is the most common cause of peptic ulcer disease?
What is the most specific diagnostic test for peptic ulcer disease?
What is the only curative tx for gastric adenocarcinoma?
A pt c/o right upper quadrant pain :20 after meals. What is the most likely dx?
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
What is the most cause of acute bacterial cholangitis?
Onion ring fibrosis from a bile duct bx should make you think of what dx?
Primary sclerosing cholangitis
What two viral hepatitis infections are self limiting?
Hepatitis A & E
Pica is often related to what type of anemia?
What does an Anti-HBc (hep B core antibody) indicate?
Previous or ongoing hepatitis B infection
What does Anti-HBs (hep B surface antibody) indicate?
Recovery from infection or immunization to hepatitis B
What is the recommended tx for hepatitis C infection?
Pegylated interferon alpha-2
What medication used in hepatitis B infection helps prevent the need for liver transplant?
There are vaccines for which 2 versions of hepatitis?
Hepatitis A and B
Will a pt c achalasia have dysphagia to liquids, solids or both?
If you have heartburn that does not improve with medication, what is the most likely dx?
What are the 2 main complications of cirrhosis?
Portal HTN and liver insufficiency
What is a good beta blocker to reduce portal HTN?
What tumor marker may be used for liver cancer?
What are the two most common causes of pancreatitis?
Cholelithiasis and ETOH
Describe Cullen's sign
Umbilical ecchymosis often related to pancreatitis
What are the 5 points of Ranson's criteria on admission?
Older than 55
What is the first step in treating GERD?
Steatorrhea should make you think of what dx?
Describe Courvoisier's sign
Nontender palpable gallbladder which may indicate pancreatic neoplasm
What tumor marker may be used to follow pancreatic cancer?
A pt c/o periumbilical pain which has now moved over McBurney's point. What is the most likely dx?
Describe the psoas sign
The pt is supine and attempts to raise the right leg against resistance
What is the term for painful swallowing?
Describe how to perform the obturator sign.
The pt is supine and attempts to flex and internally rotate the right hip
What is the best imaging study for acute appendicitis?
What 2 blood tests can be used to dx celiac?
IgA endomysial antibody and IgA tTG antibody
How much fiber should you normally get in a day?
About 30 grams
What tx should be started for asymptomatic diverticulosis?
Is surgery curative for Crohn's or ulcerative colitis?
What causes Mallory-Weiss tears?
Forced vomiting or retching (often involving alcohol)
A colonoscopy that shows cobblestone or skip lesions should make you think of what dx?
What class of medication is the first line to tx inflammatory bowl disease in the maintenance phase?
Currant jelly stool should make you think of what dx?
Severe abdominal pain :30 after a meal should make you think of what dx?
What is the most common cause of lower GI bleed?
What is the most common location of colorectal cancer?
Cecum about 38%
Colorectal pts are almost all older than what age?
90% are older than 50
An epigastric olive-shaped mass should make you think of what dx?
An elevated serum amylase and lipase should make you think of what dx?
Under routine circumstances when should pts begin getting screening colonoscopies?
What is the #1 cause of small bowel obstruction?
Air fluid levels on abdominal x-ray should make you think of what dx?
What is more likely to pass into the scrotum, a direct or indirect hernia?
A string sign on barium swallow should make you think of what dx?
What is the first line tx for an anal fissure?
Fluid and fiber
What 2 things that an anal fissure off midline might suggest?
Crohn's, syphilis, HIV, neoplasm
What medical tx is given for a gastrinoma?
Proton pump inhibitors
What is the term for an abscess in the sacrococcygeal cleft?
How do you tretH. Pylori infection?
PPI + 2 antibiotics,
Commonly omeprazole & clarithromycin & amoxicillin
PPI & metronidazole & TCN
Painless bright red blood per rectum should make you think of what dx?
A pt on sulfasalazine for an inflammatory bowel disease should be supplemented with what vitamin?
What is the most common anorectal problem affecting pts over 50?
A gastrinoma is also known as what syndrome?
Salivary amylase breaks down what macronutrient?
What is the medical term for feeling like there is a lump in your throat?
What is the most common vessel blocked with intestinal ischemia?
Superior mesenteric artery
Describe Grey-Turner's sign
Flank ecchymosis often related to pancreatitis
What are the first 3 steps of managing pancreatitis?
A pt presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely dx?
What is the most common cause of a folate deficiency?
Should diverticulitis always be admitted?
No, mild cases can be treated as outpatients with rest and clear fluids
Which NSAID has the highest rate of peptic ulceration?
What is the diagnostic test of choice for Zenker's diverticulum?
Barium swallow will show the diverticulum
What is the leading cause of iron deficiency anemia?
Chronic GI bleed
At what age and how often should fecal occult blood tests be performed as a screening tool?
Beginning at age 50, and they should be performed annually.
How often should pts with pernicious anemia have a screening endoscopy performed?
Every 5 yrs looking for signs of gastric carcinoma
Are one half of all adult hernias direct or indirect inguinal hernias?
Indirect inguinal hernias make up 50% of all adult hernias.
How is celiac disease most commonly diagnosed?
Niacin (B3) deficiency
An endoscopy for presumed esophagitis shows several solitary deep ulcers. What is the most likely dx?
Which are more painful--hemorrhoids above or below the dentate line?
Below, internal hemorrhoids are not painful.
An abdominal exam with pain out of proportion to the exam should make you think of what dx?