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GI Flashcards

1
Q

Primary sclerosing cholangitis

A

Progressive hepatic disorder in which inflammation in the liver and gallbladder causes scarring of the bile ducts

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2
Q

primary sclerosing cholangitis: labs, clinical findings

A

Labs:
-elevated alk phos
-hyperbilirubinemia

Clinical findings:
-jaundice
-pruritis
-hepatomegaly
-cirrhosis

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3
Q

Primary sclerosing cholangitis: increased risk for..

A

cholangiocarcinoma (bile duct cancer)
Hepatocellular carcinoma
gallbladder cancer
colon cancer

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4
Q

primary sclerosing cholangitis is strongly associated with which disorders?

A

IBD
ulcerative colitis

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5
Q

What is the only definitive treatment for primary sclerosing cholangitis:

A

Liver transplant
- Indicated for recurrent episodes of cholangitis, cirrhosis, complications of portal hypertension, HCC, hisar cholangiocarcinoma

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6
Q

Peptic ulcer disease: S/Sx

A

gnawing epigastric pain

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7
Q

Peptic ulcer disease: common causes

A

H. pylori – most common cause
NSAIDs

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8
Q

H. Pylori treatment

A

Two ABx:
- clarithromycin
- amoxicillin
- metronidazole
- tetracycline

PLUS

PPI: esomeprazole (20mg/day, can be given IV gtt)

+/- bismuth subsalicylate

x10-14 days

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9
Q

duodenal ulcers: presentation

A

common in ages 30-55
relief of pain with eating

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10
Q

Most common pathogens causing grossly bloody diarrhea

A

enterohermorrhagic E. coli

Also common:
- shigella
- salmonella
- campylobacter

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11
Q

Zollinger Ellison syndrome

A

Syndrome of gastric acid hypersecretion that results in severe peptic ulcer disease and diarrhea

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12
Q

Zollinger Ellison syndrome: cause

A

Excess secretion of gastrin by a gastrinoma stimulates gastric acid secretion by the parietal cells

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13
Q

Zollinger Ellison syndrome: S/Sx

A

abdominal pain and chronic diarrhea

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14
Q

NSAID-induced peptic ulcer disease: treatment

A

misoprostol

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15
Q

gastric ulcers: S/Sx

A

common in ages 55-65
pain worsens with eating

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16
Q

perforation: S/Sx

A

severe epigastric pain
rigidity, “board-like” abdomen
quiet bowel sounds

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17
Q

peptic ulcer disease: labs/Dx

A

anemia
consider endoscopy after 8-12 weeks of treatment
consider H. pylori testing

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18
Q

treatment for PUD, dyspepsia

A

acid anti-secretory agents
- PUD: start PPI first
- Dyspepsia: Start H2 reactor antagonists first

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19
Q

dyspepsia

A

recurrent indigestion or epigastric pain with no obvious cause

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20
Q

mucosal protective agents

A

Give 2 hours apart from other medications

Sucralfate
- avoid antacids and H2 blockers

Bismuth subsalicylate
- direct antibacterial action against H. pylori

Antacids
- immediate relief
- do not reduce the amount of gastric acidity

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21
Q

GERD: diagnostics

A

consider EGD

rule out:
-cancer
-Barrett’s esophagus (if GERD x5 years)
-peptic ulcer disease

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22
Q

GERD: management

A

antacids PRN
H2 blockers in high doses
PPI if H2 blockers are ineffective

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23
Q

hepatitis: types

A

Viral: A, B, C, D, E G
Autoimmune
Alcoholic

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24
Q

Hepatitis A: transmission

A

fecal-oral
-Common source outbreaks result from contaminated water and food (e.g. shellfish, hurricane-stricken areas with poor sewage)
-sexual contact

blood and stool are infectious during the 2-6 week incubation period

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25
Q

Hepatitis B: transmission

A

blood, blood products
sexual activity
perinatally mother-fetus

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26
Q

Hepatitis C: transmission

A

traditionally associated with blood transfusion
IVDU

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27
Q

hepatitis: S/Sx

A

Pre-icteric
-fatigue
-malaise
-anorexia
-N/V
-headache
-aversion to smoking and alcohol

Icteric:
-weight loss
-jaundice
-pruritis
-RUQ pain
-clay colored stool
-dark urine
-fever may be present
-hepatosplenomegaly may be present

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28
Q

hepatitis: labs/Dx

A

WBC low to normal
UA: proteinuria, bilirubinuria
AST, ALT elevated
LDH, bilirubin, alk phos, PT: normal or slightly elevated

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29
Q

Active Hepatitis A: serology

A

Anti-HAV
IgM

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30
Q

Recovered Hepatitis A: serology

A

Anti-HAV
IgG

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31
Q

Active Hepatitis B: serology

A

HBsAg
HBeAg
Anti-HBc
IgM

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32
Q

Chronic Hepatitis B: serology

A

HBsAg
Anti-HBc
Anti-HBe
IgM
IgG

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33
Q

Recovered Hepatitis B: serology

A

Anti-HBc
Anti-HBs

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34
Q

Acute Hepatitis C: serology

A

Anti-HCV
HCV RNA

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35
Q

Chronic Hepatitis C: serology

A

Anti-HCV
HCV RNA

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36
Q

hepatitis: management

A

Supportive care
Increase fluids to 3000-4000 ml/day
No/low protein diet (byproduct of protein metabolism is ammonia)
Oxazepam if sedation is necessary
Vitamin K for prolonged PT (>15 sec)
Lactulose
Antiviral drugs

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37
Q

diverticulitis: incidence

A

more common in women
higher incidence in those with low dietary fiber

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38
Q

diverticulitis: S/Sx

A

mild to moderate LLQ aching abdominal pain
constipation or loose stools may be present
N/V
low grade fever

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39
Q

diverticulitis: labs/Dx

A

leukocytosis
ESR: elevated

stool heme + in 25% of cases

sigmoidoscopy: inflamed mucosa
may consider CT to evaluate abscess
x-ray to look for evidence of free air (pneumoperitoneum)
- air under the diaphragm requires ex-lap and evacuation

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40
Q

mild diverticulitis: management

A

aspirin
high fiver diet
possible ABx therapy

41
Q

diverticulitis: inpatient management

A

NPO for bowel rest
IV fluids
Manage GIB
Surgery if indicated

42
Q

cholecystitis: S/Sx

A

often precipitated by a large or fatty meal
sudden appearance of steady, severe colicky pain in epigastrium or right hypochondriac (RUQ)
vomiting with relief
Can radiate to the back

Murphy’s sign
RUQ tender to palpation; gallbladder may be palpable
muscle guarding and rebound pain
fever

43
Q

murphy’s sign

A

deep pain on inspiration while fingers are placed under the right rib cage

44
Q

cholecystitis: labs/Dx/imaging

A

leukocytosis
bilirubin: elevated
ALT, AST, LDH, AP: elevated
amylase may be elevated

Ultrasound: gold standard
XRays may show gallstones
HIDA scan
ERCP
-complications: pancreatitis, perforation, hemorrhage, acute cholangitis

45
Q

cholecystitis: management

A

pain management
NGT for gastric decompression
NPO
crystalloids
surgical consult for lap cholecystectomy

46
Q

acute pancreatitis: causes/incidence

A

GETSMASHED

G: Gallstones
E: Ethanol, alcohol
T: Trauma
S: Steroids
M: Mass (pancreatic cancer), Mumps
A: Autoimmune pancreatitis
S: Scorpion sting
H: HLD, hypercalcemia
E: ERCP complications
D: Drugs (Depakote, Metformin, Trulicity, sulfonamides, thiazides, lasix, estrogen, azathioprine)

Most common causes: gallstones, ethanol

47
Q

acute pancreatitis: S/Sx

A

Abrupt onset of steady, severe epigastric pain worsened by walking and lying supine, improved by sitting and leaning forward
Pain usually radiates to the back but may radiate elsewhere
N/V
Weakness, sweating, anxiety
Fever
Tachycardia

Exam:
-Pallor, cool skin
-Mild jaundice common
-Upper abdomen tender to palpation usually without guarding, rigidity, or rebound
-Abdominal distention
-Absent bowel sounds if paralytic ileus present

If hemorrhagic: Grey Turner’s sign, Cullen’s sign

48
Q

Grey Turner’s sign

A

Flank discoloration
sign of hemorrhagic pancreatitis

49
Q

Cullen’s sign

A

Umbilical discoloration
sign of hemorrhagic pancreatitis

50
Q

acute pancreatitis: labs/Dx

A

leukocytosis
hyperglycemia
LDH, AST elevated
amylase, lipase elevated
BUN elevated
coagulation values elevated
hypocalcemia
-watch for Chvostek’s sign and/or Trousseau’s sign
-can lead to Torsades

CRP elevated suggests pancreatic necrosis

Contrast enhanced CT is the most reliable imaging - can identify the type of pancreatitis and any concurrent complications
Ultrasound & MRI also options but not as reliable

51
Q

Ranson’s criteria

A

5-6 factors = 40% mortality
>7 factors = 100% mortality

Geroge Washington Got Lazy After He Broke C-A-B-E

Prognostic signs at admission
-Greater than 55 years of age
-WBCs >16,000
-Glucose >200
-LDH >350
-AST >250

Prognostic signs during the first 48 hours
-Hct drop of >10
-BUN increases >5
-Calcium <8
-Arterial O2 <60
-Base deficit >4
-Estimated fluid sequestration >6000 ml

52
Q

acute pancreatitis: management

A

bed rest
NPO
aggressive IV fluids
NG suction
pain control
start clear diet once pain free and +bowel sounds

53
Q

bowel obstruction: causes

A

adhesions
hernia
volvulus
tumors
fecal impaction
ileus

54
Q

bowel obstruction: S/Sx

A

Cramping periumbilical pain initially; later becomes constant and diffuse
Minimal or no fever
Mild tenderness but no peritoneal findings
High pitched, tinkling bowel sounds
Late sign: Unable to pass stool/gas

Vomiting
-proximal: within minutes of pain
-distal: within 2 hours of pain

Abdominal distention:
-proximal: minimal
-distal: pronounced

55
Q

bowel obstruction: labs/Dx

A

late: leukocytosis, dehydration

KUB: dilated loops of bowel and air fluid levels
-SBO: horizontal staircase pattern
-LBO: frame pattern

56
Q

large bowel obstruction: imaging

A

dilated loop of bowel with air-fluid level sand a frame pattern

57
Q

SBO: imaging

A

X-ray, 2 views: ladder/staircase-like pattern of dilated small-bowel loops with air-fluid levels
No colonic distention

58
Q

bowel obstruction: management

A

IV fluids
NG suction
surgical intervention in all cases of complete obstruction
partial obstruction: treat medically

59
Q

ulcerative colitis

A

idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon
Involves the rectum and may extend upward involving the whole colon

60
Q

ulcerative colitis: S/Sx

A

bloody diarrhea

61
Q

ulcerative colitis: imaging

A

mural thickening
thumb printing

62
Q

ulcerative colitis: Dx

A

sigmoidoscopy

63
Q

ulcerative colitis: management

A

mesalamine suppositories or enemas for 3-12 weeks
hydrocortisone suppositories and enemas

64
Q

mesenteric infarct

A

a syndrome as a result of inadequate blood flow through the mesenteric circulation, leading to ischemia and gangrene of the bowel

65
Q

mesenteric infarct: causes

A

Arterial or venous embolus or thrombus
atherosclerosis
smoking
coagulopathy increases risk

66
Q

mesenteric infarct: S/Sx

A

Sudden onset of cramping, colicky abdominal pain (perhaps after eating)
Pain out of proportion to physical exam findings
N/V
Fever
Guarding and tenderness
Hyperactive to absent bowel sounds
Peritoneal findings as state progresses
Shock

67
Q

mesenteric infarct: labs/imaging

A

elevated amylase
leukocytosis

STAT CT angio of the abdomen
surgical consult

68
Q

mesenteric infarct: management

A

immediate surgical intervention

69
Q

appendicitis: S/Sx

A

Begins with vague, colicky umbilical pain that shifts to RLQ
Nausea with 1-2 episodes of vomiting
Pain worsened and localized with coughing
RLQ rebound tenderness
McBurney’s point tenderness
Psoas sign (iliopsoas test)
Obturator sign
+Rovsing’s sign
Local abdominal tenderness
Low grade fever

70
Q

McBurney’s point tenderness

A

2/3 of the distance from the right anterior superior iliac spine to the umbilicus
RLQ
Common landmark suggestive of acute appendicitis

71
Q

psoas sign (iliopsoas test)

A

pain with right thigh extension

72
Q

obturator sign

A

pain with internal rotation of flexed right thigh

73
Q

Rovsing’s sign

A

RLQ pain when pressure is applied to the LLQ

74
Q

appendicitis: labs/Dx

A

leukocytosis

CT or ultrasound is diagnostic

75
Q

IBD

A

Benign GI disorder
Diagnosis of exclusion- no pathological problems with GI system

76
Q

IBD: S/Sx

A

No weight loss
No systemic symptoms
No blood in the stool

Alternating constipation and diarrhea with relief of abdominal pain when having a bowel movement

77
Q

IBD: managmeent

A

management of diet
peppermint oil
antispasmodic therapy

78
Q

Crohn’s disease

A

Inflammatory bowel disorder in which skip lesions can occur anywhere in the GI system with a patchy distribution

79
Q

Crohn’s disease: S/Sx

A

abdominal pain
bloody stools
constipation/diarrhea
bloating
possible fever/chills

80
Q

Crohn’s disease: associated findings

A

anemia
uveitis
arthritis
erythema nodosum
skin rashes

81
Q

Crohn’s disease: management

A

dietary management
aspirin
steroids
infliximab

82
Q

Conditions associated with AST >10x normal limit

A

acute viral hepatitis
toxins
acute fulminant hepatitis
tumor necrosis

83
Q

gastroparesis is a complication of…

A

uncontrolled hyperglycemia

84
Q

gastroparesis: S/Sx

A

abdominal pain
early satiety
postprandial fullness
nausea
hypoglycemia after meals if taking rapid-acting insulin

85
Q

upper GI bleed: labs

A

hypernatremia d/t fluid loss through emesis
elevated BUN
elevated BUN:Cr ratio d/t digestion of blood or prerenal azotemia
mild leukocytosis
metabolic acidosis
elevated PTT

86
Q

upper GI bleed: management

A

NPO
NG tube
serial H/H
PPI (H2 blockers ineffective)

87
Q

preferred method of nutrition for patients who cannot eat

A

GI tract (enteral feeds) - least invasive, preserves integrity of GI tract
-parenteral nutrition is only used if enteral nutrition is contraindicated

88
Q

Formula for estimating daily caloric needs

A

calories (kcal/day) = 25-30 x wt (kg)

89
Q

giardia lamblia: presentation

A

Incubation period of 7-21 days
Diarrhea
Abdominal pain/cramping
Nausea
Greasy stools

90
Q

guardia lamblia: who is at risk?

A

People who drink contaminated water
Travelers to countries where giardiasis is common
Backpackers or campers who drink untreated water from lakes or rivers

91
Q

3 diagnostic criteria for acute pancreatitis

A

Symptoms consistent with pancreatitis (e.g. epigastric pain)
Elevation of serum amylase or lipase to 3x normal level
Radiological features consistent with pancreatitis (e.g. CT or MRI)

Diagnosis is made when 2 out of 3 criteria are met

92
Q

GI perforation: imaging

A

free air under the diaphragm

93
Q

GI perforation: presentation

A

abdominal pain
large amount of free air on abdominal films

94
Q

GI perforation: management

A

OR for immediate surgical exploration
IV fluids
NPO
Broad spectrum ABx

95
Q

GI perforation: most common cause

A

peptic ulcer disease

96
Q

hepatorenal syndrome: management

A

albumin, midodrine, and octreotide to increase circulating volume and improve renal perfusion

97
Q

Spontaneous bacterial peritonitis (SBP)

A

Complication of liver failure d/t translocation of enteric pathogens across the bowel mucosa and into the peritoneal fluid

98
Q

Spontaneous bacterial peritonitis (SBP): diagnosis

A

diagnostic paracentesis
- ascitic fluid culture

99
Q

Spontaneous bacterial peritonitis (SBP): management

A

Empiric broad-spectrum ABX for proven or suspected SBP (cefoxatime)
-narrowed when susceptibility results are available

Board Exam (18 decks)

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