GI Flashcards
(358 cards)
1
Q
acute cholecystitis sx
A
fat female fertile forty, hypoactive bowel sounds
RUQ/epigastric pain, F, leukocytosis, N/V
+ Murphys sign
+ boas sign
2
Q
acute cholecystitis test
A
initial: RUQ US TOC
gold: HIDA scan
leukocytosis w/ left shift
3
Q
acute cholecystitis tx
A
admit and supportive
IV ceftriaxone + metronidazole
cholecystectomy
4
Q
chronic cholecystitis etiology
A
recurrent acute cholecystitis
5
Q
chronic cholecystitis tx
A
emergent cholecystectomy
6
Q
emphysematous cholecystitis
A
form of acute cholangitis assoc w/ DM, vascular compromise, immunosuppression
F, RUQ, N/V, crepitus abd wall
emergent surgery and parenteral zosyn
7
Q
cholangitis what is
A
bacterial infx of biliary tract secondary to obstruction
8
Q
cholangitis MCC
A
choledocholithiasis (E. coli)
9
Q
cholangitis sx
A
charcots triad (F, RUQ, jaundice)
Reynolds pentad (Charcots + septic shock _ AMS)
10
Q
cholangitis labs
A
initial: US
cholangiography gold (ERCP)
11
Q
cholangitis tx
A
emergency tx
IV (amp-sul)
catheter drainage/ ERCP
12
Q
cholangitis complications
A
hepatic abscess: most serious, high M&M rate
13
Q
cholelithiasis patho
A
gallstones present within bladder
14
Q
cholelithiasis sx
A
fat, forty, female, fertile, fair, estrogen, OCP
asx, biliary colic, RUQ
pain after meal or at night
boas sign
15
Q
cholelithiasis test
A
abd US TOC
16
Q
cholelithiasis tx
A
asx: no tx, supportive
recurrent: cholecystectomy
17
Q
choledocholithiasis location
A
gallstone in CBD
18
Q
choledocholithiasis sx
A
asx for years
RUQ/epigastric pain, jaundice
19
Q
choledocholithiasis test
A
elevated total/ direct bill
CIT: RUQ US
gold: ERCP for Dx and tx
20
Q
choledocholithiasis tx
A
ERCP w/ spincterotomy and stone extraction w/ stent
21
Q
complication of CBD stones
A
cholangitis
obstructive jaundice
acute pancreatitis
biliary colic
biliary cirrhosis
22
Q
primary biliary cholangitis patho
A
autoimmune T cell mediated attack on bile ducts
progressive destruction of intrahepatic ducts
23
Q
primary biliary cholangitis sx
A
fatigue, pruritus, jaundice, RUQ, WL
xanthomas, xanthalasma, hyperpigmentation
24
Q
primary biliary cholangitis marker
A
+ AMA (antimitochondrial ab)
25
primary biliary cholangitis tx
1st line: ursodiol
pruritus: chilestyramine
advanced liver failure: liver transplant
26
primary biliary cholangitis complications
malabsorption
liver cirrhosis
portan HTN
osteoporosis
27
primary sclerosing cholangitis patho
progressive chronic inflammation of both intra and extra hepatic ducts
28
primary biliary cholangitis sx
pruritus, jaundice, fatigue
late: hepatomegaly, portal HTN, liver failure
itchy hands
29
primary biliary cholangitis association
male w/ hx of UC
HLA association
30
primary biliary cholangitis test
inc ALP w/ inc GGT
MRCP or ERCP
liver bx: onion skin scarring and fibrosis of bile ducts
gold: ERCP
31
primary biliary cholangitis marker
+ pANCA
32
primary biliary cholangitis tx
supplementation of fat soluble vitamins
tacrolimus, ursodiol
pruritus: cholestyramine
ERCP
liver transplant: only curative option
33
MC site of abscess/ fistula
posterior rectal wall
34
anal fissure MC location
posterior midline
35
anal fissure test
clinical
DRE/anoscopy never performed
36
anal fissure tx
1st line: stool softener, topical lido
2nd line: topical nitroglycerin or CCB (nifedipine)
alternative: botox, surgery
37
diverticulitis MC location
sigmoid colon
38
MCC lower GI bleed
diverticulitis
39
diverticulosis sx
painless rectal bleeding
40
diverticulosis test
colonoscopy gold standard
41
diverticulosis tx
high fiber foot
surgery
42
diverticulitis MC site
LLQ
43
diverticulitis sx
F, LLQ, leukocytosis
no bleeding
constipation > diarrhea
distension
44
diverticulitis test
CT w/ oral and IV contrast
45
diverticulitis test CI
barium enema
colonoscopy
can perforate
46
diverticulitis tx
cipro or bactrim + metronidazole
NPO, IVF
47
fecal impaction tx
initial; digital disimpaction and evacuation (warm water enema, mineral oil)
NG tube
abd massage
48
Hirschsprung disease association
downs syndrome
49
Hirschsprung disease sx
no passed meconium w/in 48h of birth
failed neural crest cell migration
poor feeding, abd dissension
biliary vomiting
50
Hirschsprung disease test
BIT: anorectal manometry (inc pressure)
rectal exam: explosion of gas and stool (squirt sign)
xray: complete bowel obstruction
bx definitive
51
Hirschsprung disease tx
surgery (resection of aganglionic segment followed by anastomosis of normal bowel to anus)
52
external hemorrhoid
distal to dentate line (sensate area)
53
internal hemorrhoid
above dentate line (insensate area)
54
hemorrhoids tx
1st: high fiber diet, stool softeners, sitz bath, topical analgesics, steroids
2nd line: rubber band ligation (internal), elliptical excision (thrombosed/ clotted)
3rd line: hemorrhoidectomy
55
crohns patho
inflammatory anywhere, thru entire length of intestinal wall (transmural)
56
crohns smoking
harmful
57
crohns MC area
terminal ileum
58
crohns association
HLAB27
59
crohns sx
RLQ, N/V/D (no gross blood), F, B12 deficiency
60
crohns test
endoscopy w/ bx: cobblestone appearance, skip lesions
upper GI series TOC
inc ESR/CRP
string sign
61
crohns marker
+ ASCA
62
crohns tx
1st line maintenance: mesalamine
2nd line: metronidazole
flare: systemic steroids
replace folic acid
can't be cured
63
ulcerative colitis smoking
protective
64
ulcerative colitis patho
inflammation/ulcers in colon/rectal mucosa
continuous inflammation
65
ulcerative colitis sx
abd pain, LLQ, diarrhea
gross blood, tenesmus
66
ulcerative colitis test
sigmoidoscopy/ colonoscopy TOC, definitive
stopepipe sign (dec haustral markings)
67
ulcerative colitis marker
+ PANCA
68
ulcerative colitis tx
total colectomy; curative
acute flare: systemic steroids + mesalamine enema
maintenance: mesalamine + sulfasalazine
69
ulcerative colitis complication
anemia, hemorrhage, electrolyte disturbance,
strictures, toxic megacolon, inc colon cancer risk
70
IBS association
MDD
fibromyalgia
71
IBS rome criteria
abd pain >3m w/ 2+ (improvement on defecation, change in frequency)
72
IBS alarm signs
onset after 50yo
rectal bleeding, melena
nocturnal diarrhea, progressive abd pain,
weight loss, lab abnormalities
Fhx
73
LBO MCC
adhesions
74
LBO sx
abd. pain, distension
high pitch BS
75
LBO test
abd xray: distended proximal colon, no gas in rectum, air fluid levels
76
LBO tx
admit
NG, NPO, IV fluids, rectal tube
surgery
77
rectal polyps MC area
rectosigmoid
78
rectal polyps MC sx
rectal bleeding
79
rectal polyps tx
removal
80
adematous polyps high risk cancer
villous
81
adematous polyps low risk cancer
tubular
82
rectal polyps MC type
hyperplastic
usually no tx needed, commonly removed
83
juvenile polyps (rectal)
child under 10
should be removed
84
polyps assoc w/ UC
inflammatory polyps/ pseudopolyps
85
toxic megacolon etiology
IBD
pseudomembranous colitis
C. diff colitis
86
toxic megacolon sx
F, tachycardia, leukocytosis
bloody diarrhea, vomiting
sx of shock (AMS, hypoTN)
87
toxic megacolon test
abd XR: dilation >6cm, loss of haustral markings
88
toxic megacolon tx
ICU, NG tube, NPO, IVF, electrolytes
CS, BS abx
no improvement after 24h = colectomy
bowel decompression
89
toxic megacolon complications
perforation
blood loss
septic shock
90
esophagitis MCC
GERD
91
infectious esophagitis MCC
candida (HIV/ inhaled steroids)
2nd MCC: HSV (immunocomp, organ transplant)
92
pill esophagitis med causes
alendronate
doxy
NSAIDS/ASA
93
eosinophilic esophagitis
elevated serum IgE
stacked circular ring formation
Hx allergies, atopic dermatitis, asthma
94
pill esophagitis test
small well defined ulcers of varying depths
95
esophagitis sx
odynophagia hallmark, dysphasia
retrosternal CP, cough, reflux
96
esophagitis test
endoscopy w/ bx
97
CMV esophagitis test
single large shallow and linear ulcer
98
candida esophagitis test
white well circumscribed lesions and creaming longitudinal plagues
99
HSV esophagitis test
white lesions w/ central umbilical clearing "punched out" ulcers
100
esophagitis tx
reflux: PPI
pill induced: d/c med or switch to liquid. take pills w/ water and remain upright 30m
eosinophilic: PPI, topical glucocorticoid, food allergy testing
101
pill induced esophagitis tx
d/c med or switch to liquid. take pills w/ water and remain upright 30m
102
eosinophilic esophagitis tx
PPI, topical glucocorticoid, food allergy testing
103
candida esophagitis tx
fluconazole
104
HSV esophagitis tx
acyclovir
self limiting
105
CMV esophagitis tx
gancyclovir/ fosacarnet
106
GERD patho
relaxation of LES
107
GERD test
endoscopy w/ bx TOC
24h pH monitoring gold
108
GERD tx
H2, PPI
109
GERD complication
erosive esophagitis, gingivitis, laryngitis.
stricture, esophageal ulcer, pharyngitis
barrett esophagus, pitting of dental enamel
110
mallory weiss tear tx
supportive, PPI
active bleeding: surgery (EGD w/ epi, fibrin sealant, electrocoagulation, ligation)
111
boerhaave syndrome patho
transmural rupture of distal esophagus
112
boerhaave syndrome sx
severe retrosternal CP
crepitus and crunching: hammans sign
113
boerhaave syndrome test
initial: CXR (widened mediastinum, pleural effusion, emphysema)
confirm: CT
contrast esophogram definitive
114
boerhaave syndrome tx
NPO, IV abx, IV PPI
surgical repair
115
achalasia patho
failure of LES to relax
increased LES tone
loss of auerbachs plexus
116
achalasia worldwide etiology
chagas disease
117
achalasia MC etiology
idiopathic
2nd MCC: adenocarcinoma
118
achalasia sx
progressive dysphasia (solids and liquids)
episodic regurgitation
119
achalasia test
BIT: barium swallow (bird beak, tapered)
gold: esophageal manometry
120
achalasia tx
no cure
dicyclomine
nitroglycerin
CCB (nifedipine)
botox inj to LES
pneumatic balloon most effective
121
nutcracker esophagus
excessive contractions during peristalsis
manometry (inc pressure during peristalsis)
CCB, nitrates, botox, sildenafil
122
diffuse esophageal spasm sx
CP radiates to neck
dysphagia
globus
123
diffuse esophageal spasm test
barium swallow (corkscrew during spasm)
EGD
manometry
124
diffuse esophageal spasm tx
nitrates, CCB, TCA
PPI
esophagomyotomy
125
Zenker diverticulum patho
outpouching at pharyngeal esophageal junction
near Killian triangle, posterior hypopharynx
126
MC esophageal diverticula
Zenker diverticulum
127
Zenker diverticulum sx
foul odor (halitosis)
dysphagia, choking
regurgitation of undigested food and liquid hours after eating
128
Zenker diverticulum test
best: barium swallow
129
Zenker diverticulum tx
surgery (cricopharyngeal myotomy)
130
Plummer Vinson syndrome patho
upper esophageal weblike tissue d/t severe iron def anemia. MC in postmenopausal women
131
Plummer Vinson syndrome sx
dysphagia, angular chelitis
iron deficiency anemia
koilonychia (spoon shaped nails)
atrophic glossitis
132
Plummer Vinson syndrome test
EGD
CBC: iron deficiency anemia
133
Plummer Vinson syndrome tx
esophageal balloon dilation + PPI
iron supplementation
134
Schatzki ring patho
distal esophageal web in lower esophagus @ squamocolumnar junction
from ingestion of alkali acids, bleach, detergent
135
Schatzki ring sx
intermittent solid food dysphagia and food impaction
136
Schatzki ring test
barium swallow TOC
137
Schatzki ring tx
esophageal balloon dilation + PPI
138
esophageal varices MCC
cirrhosis d/t portal HTN
139
esophageal varices sx
sudden bright red hematemesis
140
esophageal varices test
EGD: red whale markings, cherry red spots (high risk of bleed)
141
esophageal varices tx
acute: stabilize, banding, IV octreotide (TOC)
chronic: BB, ligation
abx prophylaxis: FQ/ ceftriaxone
142
celiac dz patho
a-gliadin antigen reaction causing abnormal mucosa
143
celiac dz sx
diarrhea/ steatorrhea, weight loss, bloating, anemia
easy fx, easy bleeding
dermatitis herpetiformic: pruritic rash on extensor surfaces
144
celiac dz test
definitive: small bowel bx (crypt hyperplasia)
IgG anti-tissue transflutaminase
IgA anti endomysial antibody
145
celiac dz tx
gluten free diet
iron, Ca, VitD, folate supplement
146
celiac dz risk of
intestinal lymphoma
147
lactose intolerance test
hydrogen breath test
148
nut allergy test
+ IgE antibody test
149
gastritis types
A: body
B: antrum
150
chronic gastritis MCC
H. pylori
151
acute gastritis MCC
NSAIDS/ASA
H. pylori
152
gastritis test
H. pylori breath test
EGD w/ bx MAT and gold standard
153
gastritis tx
H. pylori: clarithromycin, amoxicillin, PPI
154
peptic ulcer disease MCC
H. pylori
155
gastric ulcer sx
worse w/ food, weight loss
more likely to become malignant
older pts, type A blood
156
duodenal ulcer sx
relieved by eating, weight gain
younger, smoking
type O blood
157
MC peptic ulcer
duodenal ulcer
158
peptic ulcer disease test
initial: urea breath test/ fecal antigen test/ serology (if didn't take PPI for 2 weeks)
MAT: EGD w/ bx (r/o cancer)
159
peptic ulcer disease tx
DC meds
PPI, sucralfate, nisoprostol (only NSAID ulcers)
H. pylori tx
160
peptic ulcer disease complications
MC bleeding
ruptured peptic ulcer --> IV abx and PPT before surgery
161
pyloric stenosis sx
2wk-2mo old
projectile non bilious vomiting after feeding followed by desire to feed
palpable olive like mass RUQ
162
pyloric stenosis test
initial: abd US (mushroom/ target lesion/ string sign)
hypokalemia, hypochloremic, metabolic alkalosis
163
pyloric stenosis tx
1st: hydrate/ electrolytes, metabolic abnormalities
surgery: pyloromyotomy
164
pyloric stenosis complication
apnea
duodenal perforation
post op N/V
165
duodenal atresia association
Down syndrome
166
duodenal atresia sx
bilious vomiting in first 2 days of life
abd distension
167
duodenal atresia test
US: polyhydrominos (inability to swallow and remove amniotic fluid)
xray: double bubble sign
168
duodenal atresia tx
D/C enteral feeds
NG decompression
surgery
169
Zollinger Ellison syndrome patho
inc gastrin, stim of parietal cells --> PUD
170
Zollinger Ellison syndrome MC location
duodenum
171
Zollinger Ellison syndrome sx
abd pain, chronic diarrhea/steatorrhea
heartburn, suspected in pts w/ tx resistant PUD
172
Zollinger Ellison syndrome test
initial: EGD
confirm: inc serum gastrin concentration (gasting)
secretin stimulation test +
173
Zollinger Ellison syndrome tx
PPI or octrotide
surgery: exploratory lap and resection
metastatic: chemo
174
Zollinger Ellison syndrome MC mets
liver and abd lymphnodes
175
gastroporesis MCC
DM
post surgical
176
gastroporesis test
initial: upper endoscopy
confirm: scintigraphic gastric emptying study
177
gastroporesis tx
prokinetic therapy: metoclopramide 1st line
antiemetics
refractory: surgery, TCA
178
hepatitis A sx
MC in US and children. recent travel
jaundice, spiking fever, clay color stool, dark urine
RUQ pain, tender enlarged liver, splenomegaly
cervical lymphadenopathy
179
hepatitis A test
+ anti HAV IgM= acute infx
+ anti HAV iGM= prior infx or immunization
180
hepatitis A tx
recover in 1-2mo
routine vaccination of all children recommended
181
hepatitis A vaccine
at 12mo
182
hepatitis B RF
body fluids, unprotected sex
IVDU, vertical (mother)
183
hepatitis B sx
N/V jaundice, hepatomegaly
no fever typically
splenomegaly, adenopathy
184
hepatitis B vaccination
universal infant vaccination at birth
2mo, 6mo
185
hepatitis B immunization CI
bakers yeast allergy
186
hepatitis C transmission
blood borne, IVDU
sexual intercourse
perianal
187
hepatitis C sx
anorexia, jaundice, hepatomegaly
splenomegaly, adenopathy
188
hepatitis C test for
hepatocellular carcinoma via AFP and US
189
hepatitis D increased risk of
hepatocellular carcinoma
190
hepatitis E transmission
fecal oral
travel
191
hepatitis E sx
jaundice, fever, dark urine, clay colored stools
hepatomegaly, splenomegaly, cervical lymphadenopathy
RUQ pain
192
hepatitis E tx
self limiting
recombinant genotype 1 vaccine in endemic areas
193
hepatitis labs
inc LFT , bilirubin, PT, and globulins
194
cirrhosis causes
alcohol abuse
hepatitis B/C
NASH
hemochromatosis
195
cirrhosis sx
jaundice, hepatic encephalopathy, pruritus,
ascites, varices, gynecomastia, palmar erythema
spider angioma, caput medusa
196
cirrhosis test
initial: abd US
gold: liver bx
inc LFT, inc PT/INR
197
cirrhosis tx
tx underlying
liver transplant
lactulose, rifaximin, neomycin
198
cirrhosis screen for
hepatocellular carcinoma w/ Abd US Q6mo
AFP
199
budd chiari
hepatic vein obstruction
ascites, hepatomegaly, RUQ, abd pain
US TOC
200
most life threatening complication of portal HTN
bleeding
201
portal HTN tx
TIPS
BB
202
TIPS #1 complication
encephalopathy
203
primary biliary cirrhosis marker
anti mitochondrial ab
204
primary biliary cirrhosis tx
ursodeoxycholic acid
205
MC complication of cirrhosis
ascites
206
ascites tx
spironolactone
paracentesis
TIPS or shunt
207
1st line tx hepatic encephalopathy
lactulose
208
spontaneous bacterial peritonitis MCC
E. coli
209
spontaneous bacterial peritonitis patho
ascites fluid infection
210
spontaneous bacterial peritonitis sx
abd pain, F, chills, vomiting, rebound tenderness
AMS, ascites
211
spontaneous bacterial peritonitis test
paracentesis
gram stain w/ culture
WBC >500, PMN >250
212
spontaneous bacterial peritonitis tx
BS abx (3rd gen cef)
repeat paracentesis in 2-3d
213
direct inguinal hernia
defect of transversals fascia
Hesselbachs triangle
medial to inferior epigastric vessels
214
Hesselbachs triangle
rectus sheath edge medially
inferior epigastric vessel laterally
inguinal ligament inferiorly
215
indirect inguinal hernia
deep inguinal ring/ process vaginalis
descends in scrotum/groin
lateral to inferior epigastric vessels
216
MC child diarrhea
rotavirus
217
travelers diarrhea tx
cipro
azithromycin
prophylaxis: FQ
218
amebiasis tx
iodoquinol
flagyl for liver abscess
219
HUS MCC
shiga toxin
E. coli 0157:H7
220
HUS sx
preceding bloody diarrhea, fatigue, pallor, bruising
petechiae, oliguria
221
HUS test
schistocytes, inc bilirubin
thrombocytopenia
AKI (inc BUN, inc Cr)
222
HUS tx
fluid and electrolyte
blood transfusion
dialysis
223
MC type of bariatric surgery
sleeve gastrectomy
224
bariatric surgery gold standard
gastric bypass
225
bariatric surgery criteria
BMI >40
no success with diet/lifestyle changes
226
bariatric surgery sx
N/V cramps, flushing, diaphoresis, palpitations
soon after eating meal high in fats/carbs
227
bariatric surgery tx
diet mods
post surgical consideration: psych eval
correct vitamin deficiencies
228
MC complication bariatric surgery
dehydration
229
phelynketonuria patho
excessive phenylalanine due to failure to properly metabolize
deficiency of phenylanine hydroxylase (converts phenylalanine to tyrosine)
230
phelynketonuria sx
light complexion, musty/mousey odor, mental retardation
inc DTR, eczema
231
phelynketonuria test
newborn screen exam
inc PKU, dec tyrosine
24wk gestation
232
phelynketonuria tx
tyrosine
avoid high proteins/ phenylalanine
233
esophageal cancer worldwide MC type
SCC
234
esophageal cancer MC type US
adenocarcinoma
235
esophageal cancer SCC location and MCC
upper/mid esophagus
chronic alcohol/tobacco use
236
esophageal cancer adenocarcinoma location and MCC
distal 1/3 esophagus/ GE junction
GERD and barretts esophagus
237
esophageal cancer sx
dysphagia to solids., WL, hematemesis
+/- virchows triad
hoarse voice
238
esophageal cancer test
initial: barium swallow (apple core lesion)
definitive: endoscopy w/ bx
239
esophageal cancer tx
esophagectomy
prognosis poor
240
esophageal cancer MC mets
liver, lungs, bones
241
gastric cancer MC type
adenocarcinoma
242
gastric cancer sx
abd pain and WL
melena
virchow (supraclavicular) node
Sister Mary Joseph (umbilical lymph nodes)
243
gastric cancer test
endoscopy w/ bx MAT: leather bottle
244
gastric cancer tx
surgery
245
krukenburg tumor
ovarian mets from gastric cancer
246
bloomers shelf
palpable nodule in rectal exam
gastric cancer
247
Irish sign
left axillary lymph node
gastric cancer
248
colorectal cancer MC type
adenocarcinoma
249
colorectal cancer MC site of distant spread for colon
liver
250
colorectal cancer sx
iron deficiency anemia
abd pain, hematochezia, WL, change in bowel habits
251
colorectal cancer right sided tumor sx
blood, iron deficiency anemia
melena, change in BM uncommon
RLQ mass
252
colorectal cancer left sided tumor sx
obstruction and change in BM common
constipation/diarrhea
pencil stools
hematochezia
253
colorectal cancer test
colonoscopy most sensitive and specific
+FOBT
XR: apple core lesion
CBC: iron deficiency anemia
inc CEA
CT for staging
254
colorectal cancer screening
colonoscopy @ 50
Q10y, 5y if high risk
high risk: screen at 40yo or 10y before relatives dx
>85yo does not need colonoscopy
255
colorectal cancer tx
surgical management only curable tx
CEA level before surgery. monitor CEA w/ tx (Q 3-6mo)
256
MC site of spread for rectum
lung
257
hepatocellular carcinoma MCC
viral hepatitis (B and C)
258
hepatocellular carcinoma MC type
nonfibrolamellar: assoc w/ hepatitis B and C, cirrhosis. unresectable
259
fibrolamellar hepatocellular carcinoma
most often resectable
260
hepatocellular carcinoma RF
cirrhosis
hemochromatosis
Wilsons dz
smoking, DMT2
261
hepatocellular carcinoma sx
abd pain, hepatomegaly, WL, anorexia,
fatigue, portal HTN, ascites,
jaundice, splenomegaly
262
hepatocellular carcinoma test
initial: abd CT w/ triple phase scanning
definitive: liver bx
US: monitor high risk pts
elevation of AFP
263
hepatocellular carcinoma tx
surgical resection
transplant
chemo/rad
264
cholangiocarcinoma patho
tumor of intra- extra hepatic bile ducts
265
cholangiocarcinoma association
gallstones
cholecystoenteric fistula
porcelain gallbladder
266
porcelain gallbladder patho
intramural calcification of gallbladder wall
267
cholangiocarcinoma sx
nonspecific jaundice, colic, WL, anorexia,
RUQ mass, palpable gallbladder
obstructive jaundice, dark urine, clay colored stools, prurutis
268
cholangiocarcinoma test
cholangiography stent placement
269
cholangiocarcinoma tx
difficult to resect
prognosis bad
270
pancreatic cancer MC location and type
ductal adenocarcinoma of the head
271
pancreatic cancer sx
vague abd pain rad to back
painless obstructive jaundice
dark urine, pale stools
WL, Courvoisier sign (palpable gallbladder)
new onset DM even though pt is thin
272
pancreatic cancer test
ERCP most sensitive
CT TOC
elevated bili
273
pancreatic cancer tumor markers
CA 19-9
CEA
274
pancreatic cancer tx
resectable: Whipple
unresectable: PTC/ ERCP w/ stent
275
vitamin A deficiency alternative name
retinol
276
leading cause of preventable blindness in children
vitamin A deficiency
277
vitamin A deficiency sx
xerophthalmia
night blindness
bitot spots
immune defects
278
vitamin A excess sx
teratogenic
alopecia
hepatotoxicity
279
vitamin A sources
green leafy veggies
carrots, sweet potato, liver,
kidney, milk, egg yolk
280
vitamin B2 deficiency different name
rivaflavin
281
vitamin B2 deficiency sx
oral ocular genital syndrome
magenta tongue, angular chelitis
photophobia, corneal lesions, scrotal dermatitis
282
korkoffs dementia sx
memory loss
confabulation
irreversible
283
B1 deficiency other name
thiamine
284
B1 deficiency etiology
chronic alcoholism
285
dry beriberi sx
peripheral neuropathy
bilateral stocking glove distribution
muscle wasting
286
wernicke-korsakoff syndrome sx
wernicke encephalopathy + Korsakoff psychosis
confusion, ataxia, nystagmus
287
wet beriberi sx
cardiovascular
vasodilation, tachycardia, wide pulse pressure, sweating, warm skin, lactic acidosis. heart failure
288
wernicke encephalopathy sx
encephalopathy
ocular dysfunction (lateral rectus palsy)
gait ataxia, dec DTR
289
wernicke encephalopathy tx
IV thiamine then glucose infusion
290
vitamin B6 deficiency sx
peripheral neuropathy
stomatitis
glossitis
flaky skin, anemia
291
vitamin B6 deficiency patho
deficiency in pyridoxine from isoniazid
ETOH
292
niacin deficiency sx
pellagra (raw skin)
four D: diarrhea, dementia, dermatitis, death if not tx
293
niacin deficiency diet
meat, fish, liver, white grains, green leafy veggies
294
vitamin C deficiency sx
3 H: hyperkeratitis, hemorrhage, hematologic
bleeding gums, pseudo paralysis, petechial hemorrhages, impaired wound healing, glossitis
295
vitamin C deficiency tx sources
citrus, spinach, cauliflower, liver, kidney
296
rickets sx
seizures, tetany,
297
osteomalacia sx
potbelly, delayed milestones,
Harrison groove
298
rickets/osteomalacia labs
dec VitD, dec Ca
dec P, inc ALP
299
acute pancreatitis causes
gallstones
etoh abuse
300
acute pancreatitis sx
epigastric pain radiating to back
relieved by sitting up or bending forward
F, leukocytosis, hypoTN
301
acute pancreatitis hemorrhagic sx
Cullen sign
gray turner sign
fox sign
302
acute pancreatitis test
inc amylase (MC), lipase (specific)
CT TOC
303
acute pancreatitis tx
fluid resus
pain management
severe: ICU
304
chronic pancreatitis sx
chronic pain w/ flare ups
epigastric pain rad back, steatorrhea
triad: malabsorption, inc glu, pancreatic calcifications
305
chronic pancreatitis test
CT initial TOC
ERCP gold
amylase and lipase normal
306
chronic pancreatitis tx
getoclopramide: gastroporesis
analgesics, NPO
pancreatojejunosomy
307
pancreatic pseudocyst sx
acute pancreatitis hx
dull abd pain, epigstric abd mass
308
pancreatic pseudocyst test
CT w/ contrast preferred
fluid analysis
309
pancreatic pseudocyst tx
resolve w/ supportive care
1st line: NG, PPI, octreotide
2nd line: pseudocyst endoscopic drainage or catheter drainage
3rd line: surgery (necrosis)
310
acute mesenteric ischemia sx
hx afib, MI, CAD
pain out of proportion
lactic metabolic acidosis
311
acute mesenteric ischemia test
initial: CTA
mesenteric angiography gold
312
acute mesenteric ischemia tx
supportive
surgical
arterial; papaverine (vasodilator)
venous: heparin
embolic: thrombolytic or embolectomy
313
acute mesenteric ischemia avoid
vasopressors
314
intussusception sx
colicky abd pain, palpable sausage shaped mass, currant jelly stool, RUQ pain
dance sign, vomiting
315
intussusception test
BIT: US (target sign)
best confirmatory: barium/contrast enema
316
intussusception tx
stable: IV fluids, NG, reduction via pneumatic enema (air pressure)
surgical if acutely ill or perforation
317
small bowel obstruction MCC
surgical adhesions
318
small bowel obstruction sx
colic abd pain, N/V, no passage of gas/feces, dissension, high pitch BS, visible peristalsis
319
small bowel obstruction test
XR: ladder pattern (proximal dilated loops/ minimal gas)
string of pearls
320
small bowel obstruction tx
non operative: IV fluids w/ electrolytes, NG, NPO, IV analgesica and abx
surgery if persistent or strangulation
laparotomy w/ lysis of adhesions and resection of necrotic bowel
321
paralytic ileus etiology
opioids
post op
antidepressants, anticholinergics
hypokalemia
322
paralytic ileus sx
distension, obstipation, minimal/absent abd pain,
absent/ dec BS
323
paralytic ileus test
abd XR TOC: uniform distribution of gas
324
paralytic ileus tx
IVF, NPO, NG
resolves w/ time
surgery only if sx of peritonitis
325
volvulus sx
newborns
bilious vomiting, abd distension
blood streaked stools, melena
shock
326
volvulus test
abd XR: double bubble sign
upper GI contrast/ contrast enema needed for dx
327
malrotation and volvulus test
corkscrew or beaked appearance w/ dilated bowel loops
328
volvulus tx
surgery
decompression or adds procedure
329
upper GI bleed location
above ligament of treats
330
upper GI bleed sx
melena
hematemesis
331
upper GI bleed tx
TEGD w/ coagulation of bleeding vessel
ligation
332
lower GI bleed location
below ligament of treitz
333
lower GI bleed tx
may stop spontaneously
supportive
colonoscopy
334
gilbert syndrome
jaundice w/ stress, etoh, illness
no tx
335
Crigar najjar
neonatal jaundice
phototherapy --> week 2, kernicterous
liver transplant definitive tx
if asx, phenobarbital
336
bilirubin (gilbert, criger, dubin)
gilbert and criger najjar: increase in unconjugated bili
dubin johnson: increase in conjugated bilirubin
337
Dubin johnson
grossly black liver on bx
no tx
338
rotors syndrome
mild dubin johnson
conjugated and nonconjugated bili
no black liver
339
hemochromatosis patho
excessive iron absorption in intestine
autosomal recessive
340
hemochromatosis sx
fatigue, arthritis, impotence, amenorrhea,
abd pain, arrhythmias
hyperpigmentation (bronze like)
341
hemochromatosis test
genetic testing
confirm: iron studies and liver bx
342
hemochromatosis tx
repeated phlebotomies TOC
advanced: liver transplant
343
Wilsons disease patho
impairment of copper excretion into bile
autosomal recessive
ATP7B mutation
344
Wilsons disease sx
Kayser Fleischer rings
liver disease, acute hepatitis, cirrhosis
parkinsonian like sx
345
Wilsons disease test
liver bx (elevated copper concentration)
dec ceruloplasmin
inc urine copper
346
Wilsons disease tx
chelating agents (d- penicillamine)
zinc
347
PPI AE
long term: osteoporosis
pneumonia
348
sucralfate AE
constipation
349
bismuth AE
harmless black coating of stool
350
misoprostol AE
diarrhea
351
zofran AE
HA, constipation
QT prolongation
352
metoclopramide AE and CI
acute dystonia
CI: parkinsons
353
esophageal atresia patho
absence or closure of esophagus
MC assoc w/ tracheoesophageal fistula
354
esophageal atresia sx
excessive oral secretions immediately after birth
355
esophageal atresia test
inability to pass NG further than 10-15cm
fluoroscopy
356
esophageal atresia tx
surgical ligation of fistula
357
anticholinergic toxicity sx
xerostoma, AMS, tachycardia
urinary retention, mania, delirium
erythema, dry skin
358
TCA AE
dry skin, dry mouth, dilated pupils, dec breath sounds
AMS, arrhythmias, hypoTN
