GASTROINTESTINAL Flashcards
1
Q
Organisms that produce ENTEROTOXIN. Prominent symptoms include Vomiting and diarrhea (watery). Incubation period 8-72 hrs.
A
- V. cholerae
- Enterotoxigenic E.coli
- K. pneumoniae
- Aeromonas spp
2
Q
There is an interval between the disappearance of HBsAg and the appearance of anti-HBsAb. This period is referred to as the ____.
A
WIndow period
During this interval, anti–hepatitis B core antigen (anti–HBc) is the only detectable serology
3
Q
MOST common cause of LGIB
A
Hemorrhoids
4
Q
GASTRIC OR DUODENAL ULCER?
Risk of Malignancy is common and should be biopsied
A
Gastric ulcer
5
Q
In the ICU setting, a rising ___ may be a sign of an occult GI bleeding.
A
BUN
6
Q
What are the two types of gallstones?
A
o Cholesterol stones (90%): contain >50% cholesterol monohydrate
o Pigment stones: composed primarily of Ca2+
- Black type (common in those with chronic hemolytic states)
- Brown type (due to chronic biliary infection)
7
Q
Benign GUs are MOST often found
A
DISTAL to the junction between the antrum and the acid secretory mucosa
8
Q
What is the most common non-infectious cause of acute diarrhea?
A
Side effect of medications
9
Q
“Cork-screw” esophagus
A
Diffuse esophageal spasm
10
Q
Now the single most common risk factor for Hepatitis C is ____
A
injection drug use
11
Q
Best diagnostic work-up for pancreatitis
A
CT scan of the abdomen with IV contrast (done 3-5 days into hospitalization when patients are not responding to supportive care to look for local complications such as necrosis)
12
Q
urgent endoscopy age cutoffs are:
A
- >55 for dyspepsia with alarm
- >40 for PUD with alarm
13
Q
Common first line H. pylori treatment:
A
o Triple therapy: “OCA” - Omeprazole + Clarithromycin + Amoxicillin
o Quadruple therapy: “TOMB” - Tetracycline + Omeprazole + Metronidazole + Bismuth
14
Q
n children and adolescents – MOST common colonic cause of significant GIB
A
IBD and juvenile polyps
15
Q
Loperamide dose.
A
Loperamide 4mg/tab 1 tab as initial dose then 2mg after each loose stool is recommended. Maximum dose of Loperamide is 8mg/day.
16
Q
Most severe histologic consequence of GERD
A
Barrett’s metaplasia with the associated risk of adenocarcinoma
17
Q
How do you classify hemorrhoidal disease?
A
o External hemorrhoids: originate below dentate line, covered by squamous epithelium, and are painful when thrombosed
o Internal hemorrhoids (majority): originate above dentate line, covered with mucosa
18
Q
aberrant blood vessels from dilatation of the terminal aspect of the blood vessel
A
Angioectasia
19
Q
AST:ALT < 1
A
chronic viral hepatitis, NAFLD
20
Q
What is the initial treatment of cirrhotic ascites?
A
Restriction of sodium intake (next line of management: Spironolactone + Furosemide)
21
Q
presence of IDA, weight loss, symptoms of obstruction, abdominal pain, BM changes
A
Colonic mass
22
Q
most frequent visceral site of metastasis of colon CA
A
Liver
23
Q
the first serologic marker to appear after infection with Hepatitis B. This is repeated after 6 months for those who had an acute Hepatitis B infection to document chronicity
A
HBsAg
24
Q
AST:ALT > 2
A
alcoholic liver disease
25
GOLD standard for confirmation of Barrett's esophagus
Endoscopic biopsy
26
Child-Pugh classification of liver failure is still a reliable prognosticator for tolerance of hepatic surgery – only Child A should be considered for resection. Enumerate the components for scoring.
27
Useful INITIAL diagnostic test when mechanical obstruction is suspected
Endoscopy
28
Procedures of choice for visualization of biliary tree
ERCP, MRCP
29
Gold standard in diagnosing most liver diseases
Liver Biopsy
30
Differentiate Ulcerative colitis from Chron's disease
31
distinguish portal HPN vs nonportal HPN
**Serum-ascites-albumin-gradient (SAAG):**
o **SAAG ≥1.1 g/dL:** presence of **portal hypertension**
o **SAAG \<1.1 g/dL:** not related to portal hypertension
32
Charcot’s triad of cholangitis:
o Fever
o Pain
o Jaundice
33
What is the mainstay of treatment for hepatic encephalopathy?
Lactulose
34
drop in systolic pressure of \> 20 mm Hg or a rise in pulse of \> 10 beats per minute
Orthostasis
35
Two predominant causes of PUD
NSAID ingestion infection
36
Forrest classification of ulcers
37
Non-invasive H.pylori tests
Urea breath test
Serology
Stool Angtigen
38
liver or biliary tract disease, Dubin-Johnson, Rotor
Conjugated bilirubinemia
39
**GASTRIC OR DUODENAL ULCER?**
Precipitated by food
GASTRIC ULCER
40
Cervical CA screening
at age 21-65 PAP every 3 years
41
predominates during 1 st 6 months after acute infection. **Present even at the window period**
IgM Anti-HBc
42
MOST common esophageal symptom
Heartburn / pyrosis
43
Review the serology in viral Hepatitis B
44
an area of discoloration in the periumbilical area seen in pancreatitis
Cullen sign is a hemorrhagic discoloration of the umbilical area due to intraperitoneal hemorrhage
45
hallmark symptom of liver disease & most reliable marker of severity
Jaundice
46
Organisms that produce **PREFORMED TOXINS.** Prominent symptom include **vomiting and watery diarrhea**
* Bacillus cereus
* Staphylococcus aureus
Clostridium perfringens
47
Tests to document H. pylori eradication (think GI tract as the source!):
o Urea breath test (gastric) - test of choice
o Stool antigen (intestines)
o Rapid urease test (gastric)
48
Most common complication of peptic ulcer disease (PUD)
GI bleeding
49
Stigmata of Cirrhosis
**o Palmar erythema o Spider angiomata o Gynecomastia o Testicular atrophy o Dupuytren’s contractures o Caput medusae**
50
Organisms that produce CYTOTOXIN. Prominent symptom is crampy abdominal pain.
* C. difficile
* Hemorrhagic E.coli
51
Staging and Treatment of hemorrhoids
52
Mass located in this location:
§ develop obstruction and even perforation
§ X-ray often shows **“apple-core or napkin-ring” deformity** annular, constricting lesion
transverse and descending colon
53
MOST frequent finding in GU or DU
Epigastric tenderness
54
Level of obstruction in the portal venous system in portal hypertension due to Budd-Chiari syndrome
Posthepatic
55
most important treatment intervention in pancreatitis
Safe, aggressive intravenous fluid resuscitation
56
first line ancillary procedure if blood tests suggest cholestasis
Ultrasound
57
Classification of portal HTN
58
Procedure of choice for detection of stones?
Gallbladder UTZ
59
indicates presence of portal hypertension
**SAAG ≥1.1 g/dL**
60
The **Bedside Index for Severity in Acute Pancreatitis (BISAP**) score has been developed to identify patients at high risk for mortality or severe disease early during the course of acute pancreatitis.
The **Ranson criteria** form a clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis.
Enumerate the parameters for the scoring.
61
GASTRIC OR DUODENAL ULCER?
* Occurs 90 min to 3 hrs after a meal
* Relieved by antacids or food
DUODENAL ULCER
62
Test of choice for documenting eradication of H.pylori
Urea breath test
63
Mainstay of treatment of nonalcoholic fatty liver disease
Weight loss and exercise
64
Endoscopic therapy of CHOICE for esophageal varices
Ligation
65
recommended as the initial test in unexplained dyspepsia \>55 years old or who have alarm factors because of the purported elevated risks of malignancy and ulcer
Upper endoscopy
66
MOST common cause of UGIB
Peptic ulcer
67
CENTRAL role in gastric epithelial defense/ repair
Prostaglandin
68
drop in blood pressure or rise in pulse from a lying to a standing or seated position
Orthostatic hypotension
69
If local anal processes, which rarely require hospitalization, are excluded, the most common causes of LGIB in adults are \_\_\_\_\_\_\_\_\_\_\_\_
diverticula, vascular ectasias (especially in the proximal colon of patients \>70 years), neoplasms (primarily adenocarcinoma), colitis (ischemic, infectious, idiopathic inflammatory bowel disease), and post- polypectomy bleeding.
70
Phase of hepatitis characterized with Anorexia, nausea, vomiting, malaise, arthralgia, headache, pharyngitis, cough, coryza **precede onset of jaundice by 1-2 weeks**
Prodromal phase
71
Responsible for MAJORITY of cases of obscure GIB
Small intestinal sources of bleeding
72
\_\_\_\_\_\_\_\_ is the leading cause of acute pancreatitis; followed by alcohol.
gallstone
73
Alkaline phosphatase \> AST, ALT
cholestatic conditions
74
CLASSIC symptoms of GERD
Water brash and substernal heartburn
75
Alarming manifestations (requiring endoscopy)
o Dysphagia
o Weight loss
o Anemia
o Bleeding
76
77
Presence of scleral icterus indicates total bilirubin level of at least \_\_\_
2.5-3mg/dL
78
Elevation of AST/ALT \>1000 U/L
o Viral hepatitis
o Ischemic liver injury
o Toxin- or drug-induced liver injury
79
Lung CA screening
at age **55-80** if with at least 30 pack years of smoking history, and have been smoking for the last 15 years, do a plain chest CT scan at least once
80
Most common organism in spontaneous bacterial peritonitis (SBP)
Escherichia coli
81
MOST common cause of significant lower GIB in children
Meckel’s diverticulum
82
MOST common cause of esophageal chest pain
Gastroesophageal reflux
83
MAINSTAY of treatment of PUD
Eradication of H. pylori and therapy / prevention of NSAID induced disease
84
treatment for chronic hepatitis B infection and is part of an antiretroviral prophylaxis if the patient was HIV positive.
Oral Lamivudine
85
MOST potent acid inhibitory agents available
Proton Pump inhibitors
86
most discriminating symptom of duodenal ulcer
Pain that awakens the patient from sleep
87
MOST sensitive test for diagnosis of GERD
24-h ambulatory pH monitoring
88
most common physical sign (50-90%) of hepatocellular CA.
Hepatomegaly
89
manifesting as ecchymosis or discoloration of the flanks. seen in pancreatitis
**Grey Turner's sign r**efers to an uncommon subcutaneous manifestation of intra-abdominal pathology manifesting as ecchymosis or discoloration of the flanks.
90
mass in this location become large without any obstructive symptoms or bowel habit changes. But they commonly ulcerate leading to chronic blood loss (IDA)
cecum and ascending colon
91
Invasive H.pylori tests
Rapid urease test
histology
culture
PCR assay
92
Smoking and appendectomy are protective to what type of IBD?
Ulcerative Colitis
93
Characteristic symptom of infectious esophagitis
Odynophagia
94
for diagnosis of Hepatitis C (no way of determining acute vs chronic Hep C infection via serology)
Anti-HCV
95
Breast CA screening
at age 50-74 mammography every 2 years
96
Duodenal ulcers occur MOST often in what specific location
FIRST portion of the duodenum (\>95%)
97
Differentiate types of diarrhea according to duration :
**o Acute: \< 2 weeks**
**o Persistent: 2-4 weeks**
**o Chronic: \> 4 weeks**
98
most common and most characteristic symptoms of liver disease, typically occurs after activity or exercise, rarely after adequate rest (afternoon rather than morning fatigue)
Fatigue
99
What are the three hemorrhoidal complexes that traverse the anal canal?
**Left lateral, right anterior, and right posterior**
100
KEY enzyme that controls the rate-limiting step in prostaglandin synthesis
Cyclooxygenase (COX)
101
What is the next step if esophageal varices are documented?
Endoscopic ligation and IV vasoactive medications (e.g., octreotide)
102
Hemorrhoid stage where sclerotherapy is the treatment of choice
Stage I with enlargement and bleeding
103
marker for hepatitis A during the acute illness, may persist up to several months
IgM Anti-HAV
104
Significant alcohol intake
Alcohol intake of **30g** or more (3 Pilsen cans) everyday
105
the most common cause of death in pancreatitis
Hypovolemic shock
106
BT is recommended when Hgb \_\_\_\_
Hgb \< 7g/dL
107
classic history of vomiting, retching, or coughing preceding hematemesis, especially in alcoholic patient. Commonly in gastric side of GEJ.
Mallory-Weiss tear
108
“Ulcer definition” is ____ depth
\>5mm
109
Prostate CA screening
start at age 50
110
Organisms that produce ENTEROADHERENT TOXIN. Prominent symptom is crampy abdominal pain. Incubation period 1-8 days.
* Enteropathogenic E. coli
* Enteroadherent E.coli
* Giardia
* Cryptosporidiosis
* Helminths
111
gold standard treatment for high-grade dysplasia
Esophagectomy
112
What important serologic test would you request to check for acute viral hepatitis A and B?
**Anti-HAV IgM**
**HBsAg and Anti-HBc IgM**
113
**GASTRIC OR DUODENAL ULCER?**
Pathophy: Gastric acid output **normal or decreased**
Gastric Ulcer
114
What is the characteristic bleeding of diverticular bleeding?
Abrupt in onset, painless, sometimes massive, and often from the right colon (chronic/occult bleeding is not characteristic)
115
MOST common cause of obscure GIB in adults
* Vascular ectasia, tumors, NSAID induced
* For \<40-50 years: small bowel tumors
* For \>50-60 years: vascular ectasia, NSAID-induced
116
Screening for colon CA schedule:
• At age **50** (10 years younger if with one first degree relative with Colon
CA and if with consideration of familial polyposis start at age 25)
o **colonoscopy every 10 years**
o **Sigmoidoscopy every 5 years**
o **FOBT annually**
117
hemolysis, Crigler-Najjar, Gilbert
Unconjugated bilirubinemia
118
Standard indications for testing for H. pylori
* Active PUD
* History of PUD without prior treatment
* MALT
* Uninvestigated dyspepsia (if population prevalence \>20%)
119
Triad for cholecystitis
RUQ tenderness, fever, leukocytosis
120
What are the markers for chronic hepatitis?
Persistence of HBsAg or HBeAg
121
represents high level of viral replication and high infectivity
**Hepatitis B precore antigen (HBeAg)**
122
Defined as ≥3 months of bothersome postprandial fullness, early satiety, or epigastric pain or burning with symptom onset at least 6 months before diagnosis in the absence of organic cause
Functional dyspepsia
123
protruding rectal mass with occasional pain and blood streaked stools
Hemorrhoidal bleeding
124
Melena: indicates blood present in GIT for at least \_\_\_\_\_\_
14 hours and as long as 3-5 days
125
Most important mechanism in formation of stone-forming bile?
Increased biliary secretion of cholesterol
126
Test of Choice:
## Footnote
* UGIB: \_\_\_\_\_\_\_
* LGIB (unless with massive bleed): \_\_\_\_\_
* Massive obscure bleed: \_\_\_\_\_
* UGIB: upper endoscopy
* LGIB (unless with massive bleed): colonoscopy
* Massive obscure bleed: angiography
127
Complications of PUD
Most common: **gastrointestinal bleeding**
Second most common: **perforation**
Least common: **gastric outlet obstruction**
128
Portal HPN: defined as elevation of hepatic venous pressure gradient \>\_\_\_\_
**\>5 mmHg**
129
**GASTRIC OR DUODENAL ULCER?**
Gastric acid output is increased and HCO3 secretion is decreased
Duodenal Ulcer
130
infectious, ischemic, drug-induced (NSAID); frequently accompanied by diarrhea
Colitis
