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Flashcards in GI 1 (Step up son) Deck (34):
1

What causes viral gastro in adults? Kids?

Norwalk virus*
Coxsackie
Echovirus
Adenovirus

Rotavirus

2

What is the most common foodborne bacterial GI infection?

Salmonella (causes bloody diarrhea)

3

What pathogen in undercooked pork can cause GI and/or CNS symptoms? How is it treated?

Taenia solium

GI: praziquantel
CNS: albendazole + corticosteroid

4

Patient has a hard time swallowing solids, but does okay with liquids. What type of dysphagia is this?

Obstructive

5

Patient has a hard time swallowing solids and liquids. What type of dysphagia is this?

Neuromuscular

6

What are secondary causes of achalasia?

Chagas disease
Neoplasm
Scleroderma

7

Patient has chest pain and dysphagia. so you get a barium swallow and it shows a corkscrew. What is this?

Diffuse esophageal spasm

Nitrates relieve pain...if it were GERD, it would worsen the pain

8

What kind of esophageal cancer is most common world wide? In the US?

Squamous cell carcinoma

Adenocarcinoma

9

There are two types of chronic gastritis: Type A in the fundus (10%) and Type B in the antrum (90%). What causes Type A? what are associated conditions?

Autoantibodies for parietal cells

Pernicious anemia
Achlorhydria
Thyroiditis

10

There are two types of chronic gastritis: Type A in the fundus (10%) and Type B in the antrum (90%). What causes Type B? what are associated conditions?

H. pylori

PUD
Gastric cancer

11

What are Curling ulcers? Cushing ulcers?

Curling ulcers are secondary to stress from a severe burn

Cushing ulcers are from intracranial injuries

12

Which artery is concerning when it comes to PUD?

Gastroduodenal artery...posterior ulcers can erode into it

13

Where are Zollinger-Ellison tumors usually located?

Duodenum (70%)
Pancreas

14

There are four types of gastric cancers: Ulcerating, Polypoid, Superficial spreading, and Linitis plastica. Which has the best prognosis? Worst?

Superficial spreading has the best prognosis

Linitis plastica (all layers are involved) has a poor prognosis

15

What are some signs of a gastric cancer outside of gastric symptoms? Abnormal lab?

Virchow node (left supraclavicular lymph node)
Sister Mary Joseph node (Periumbilical node)

Carcinoembryonic Antigen (CEA)

16

When would a D-xylose test be ordered (for malabsorption)? what does it indicate?

D-xylose is ordered if patient has a positive Sudan stain (indicates steatorrhea)

Normal D-xylose --> assess for pancreatic insufficiency
Abnormal D-xylose --> small biopsy (sprue vs whipple vs bacterial overgrowth)

17

When is a Schilling test done (for malabsorption)? What does it indicate?

Schilling test is done when a Sudan stain is negative and stool has a normal pH

Abnormal 1st stage and normal 2nd stage --> Pernicious anemia
Abnormal 1st and 2nd stages --> consider ileal disease or bacterial overgrowth

18

A patient comes in concerned about diarrhea, weight loss, joint pain, fever, and vision changes. On exam, found to have a new heart murmur. What is a likely diagnosis? What test should be done? How should it be treated?

Whipple disease (tropheryma whippelii)

Jejunal biopsy: periodic acid-Schiff (PAS) stain --> foamy macrophages; villous atrophy

Bactrim or ceftriaxone x 12months...often fatal if untreated

19

A patient is being worked up for chronic diarrhea and is found to have a high osmotic gap (290 -2[Na+ + K+]) > 125. What should be done next? what does it indicate?

Sudan test...looks for fat

Normal fat --> laxative abuse
High fat --> workup for malabsorption or pancreatic disorder

20

A patient is being worked up for chronic diarrhea and is found to have a high osmotic gap (290 -2[Na+ + K+]) less than 50. What should be done next? what does it indicate?

Weigh stool

normal --> IBS
Increased --> laxative abuse

21

What are the Manning criteria for IBS?

Pain relief w/ defecation
More frequent poops following onset of pain
Looser poops following onset of pain
Visible abdominal distention
Passage of mucus with stool
Feeling of incomplete emptying

Likelihood of IBS increases with each criteria met

22

In differentiating b/w Crohn's and UC, which has increased antiyeast Saccharomyces cerevisiae antibodies (ASCA)?

Crohn's

23

In differentiating b/w Crohn's and US, which has increased pANCA?

UC

24

What is the cure for UC? Should it be considered?

Colectomy...should be done, significantly increased risk of CRC w/ UC

25

What hurts more, ischemic colitis or small bowel ischemia?

Small bowel ischemia...tender out of proportion to exam

26

What is the most common cause of acute lower GI bleeding in patients >40yo?

Diverticulosis

27

What is a carcinoid tumor? Where do they often locate?

Tumor that arises from neuroectodermal cells that function in amine precursor uptake and decarboxylation (APUD)

Bronchopulmonary tree, ileum, rectum, appendix

28

When does a carcinoid tumor really become symptomatic? What are the symptoms?

When there are liver or extragastrointestinal involvement

Serotonin secretion --> flushing, diarrhea, bronchoconstriction, tricuspid/pulmonary valvular disease

29

How are carcinoid tumors treated?

Tumors less than 2cm --> resection
Tumors greater than 2cm --> extensive resection
Metastatic disease --> IFN-alpha, octreotide, and embolization

30

Where does CRC typically metastasize to?

Lung
Liver

31

What is Gardner syndrome?

FAP + bone and soft tissue cancers

32

A patient has mucocutaneous pigmentation of mouth, hands, and genitals. What should be looked for?

Peutz-Jeghers syndrome...hamartoma polyps with low risk of malignancy

33

A patient has many colonic adenomas and comorbid malignant CNS tumors. What does this person have?

Turcot syndrome...highly malignant

34

Where can polyps with juvenile polyposis be?

colon, small bowel, and stomach...often cause GI bleeding

slightly increased risk of malignancy later in life