GI Flashcards
(531 cards)
1
Q
relaxation of what structure causes GERD?
A
lower esophageal sphincter
2
Q
What substances would most likely cause GERD?
A
smoking
3
Q
Patients may complain of what with GERD?
A
hoarseness
4
Q
What surgery would be indicated if medication did not work for sx associated with hiatal hernia
A
fundoplication
5
Q
Regarding Gerd, what test would be used if a trial of empiric therapy did not work?
A
Endoscopy
5
Q
between reflux esophagitis and esophageal cancer is?
A
barret’s esophagitis
6
Q
Upper part of the stomach bulges through an opening in the diaphragm
A
hiatal hernia
7
Q
barret’s esophagitis is considered?
A
precancerous
8
Q
Patients with barrets esophagitis should have ______ every 6 months to 3 years?
A
endoscopy
9
Q
eosinophilic esophagitis is most associated with?
A
atrophy
10
Q
Which medication is most likely to cause medication-induced esophagitis?
A
bisphosphonates
11
Q
a muscle tear as the GE junction
A
mallory weis tear
12
Q
mallory weis tears are associated with
A
bulimia nervosa
13
Q
treatment for bleeding esophageal varices
A
emergent endoscopy
13
Q
the portal system takes blood from the _____ and takes it to the _________
A
organs, liver
14
Q
what are one of the complications of portal hypertension?
A
esophageal varices
15
Q
In patients with bleeding esophageal varices, what can be used to help prevent bleeding?
A
beta blockers
16
Q
T or F: tobacco use is a RF for esophageal cancer
A
true
17
Q
progressive dysphagia to SOLIDS and LIQUIDS
A
achalasia
17
Q
H pylori infection is transmitted
A
fecal oral and oral and oral
18
Q
finding on barium swallow with achalasia
A
birds beak
19
Q
how to make a definitive diagnosis of esophageal cancer?
A
endoscopy with biopsy
20
Q
What test is used to diagnose can be used to diagnose H. pylori
A
urea breath test
21
Q
upper GI bleeding can present with?
A
coffee ground emesis
22
T or F: therapy for h. pylori combines antibiotics and H2 blockers
F
23
how long is the treatment for H. pylori?
14 days
24
zollinger ellison syndrome causes an increase in _______ secretion
gastrin
25
when do gastric ulcers produce pain
1-2 hours after eating
26
gastric adenocarcinoma is most prevalent in?
asia
26
Which drugs are first line treatment for gastrc ulcers?
PPI and H2 blockers
27
Which disease has the sister mary joseph sign?
gastric carcinoma
28
What type of PUD is more common?
duodenal ulcers
29
What descirbes the pain of duodenal ulcers
relieved with food
30
What surgery is indicated for treatment for duodenal ulcer?
vagotomy
31
appendicitis pain typically beings in the ______ regiona
periumbilical
32
for kids, _________ is the preferred test for appendicitis
US
32
an ileus refers to an obstruction of the?
small bowel
33
What is the most common cause of an ileus?
adhesions
34
a hernia that loses it blood supply is called?
strangulated
35
What is this picture?
intussuception
36
most polyps in the small intestine are?
benign
37
celiac sprue is caused by an _______ response to _______
immune, gluten
38
serum test for celiac disease
IgA tissue transglutaminase
39
Most common cause of acute mesenteric ischemia?
arterial occlusive disease
40
What is the test for acute mesenteric ischemia?
CTA
41
What is the risk for diverticulitis?
chronic constipation
42
What is the diagnostic test for diverticulitis?
CT
43
with diverticulitis, pain is typically in the
LLQ
44
What is the antibiotic of choice for MILD diverticulitis?
cipro/metronidazole
45
diet recommendation for diveticulitis
high fiber
46
mouth to anus
Crohns
47
skip lesions
Crohns
48
Crohns disease typically has pain in the
RLQ
49
medication for acute flair of Crohn
steroids
50
starts at rectum and moves proximally
UC
51
pain with UC is in the
LLQ
52
sandpaper appearance on colonoscopy
UC
53
this can occur primaily with diarrhea, primayly constipation, or alterating
IBS
54
this class of medications may be helpful in patients with IBS
SSRI
55
antibiotic colitis is associated wuth which bacteria?
C. diff
56
the underlying mechanism of antibiotic-associated diarrhea is?
disruption of microflora
57
of the following, which is a correct option for treatment of antibiotic-associated diarrhea?
Vanc PO
58
in toxic megacolon, the colon is dilated more than?
6 cm
59
colon dialtion is the ONLY diagnostic criteria for toxic megacolon
false
60
What is the underlying mechanism of ischemic colitis?
hypotension
61
passage of red or maroon stool is associated with?
ischemic colitis
62
what surgery may be indicative of ischemic colitis?
bowel resection
63
the most common cause of large bowel obstruction is?
carcinoma
64
at what age is a colonoscopy recommended for colon cancer screening in an individual with no family history
45
64
Adenomatous polyps are present in _________ of adults, of those ____________ will become malignant
30%, 1%
65
management of familial adenomatous polposis
prophylactic colectomy
66
90% of colon cancers are
adenocarcinoma
67
labs used to monitor colon cancer
CEA
68
When colon cancer is diagnosed in an early stage, what is the survival rate?
very good
69
what medication is a common cause of constipation?
opiates
70
a 40 year old male with constipation and no alarm sx should?
take polyethylene glycol
71
treatment for fecal impaction?
disimpaction
72
internal hemorrhoids are
painless
73
which condition is a risk factor for hemorrhoids
pregnancy
74
What is the cause of most large bowel obstruction?
neoplasms
75
usually described as a tearing sensation
anal fissure
76
what is this?
familial adenomatous polyposis
77
What is an alarm sx with regard to constipation?
change in caliber of stools
78
What is the initial treatment for constipation?
behavioral changes
79
T or F: patients with fecal impaction can have diarrhea
true
80
blood, pus, or fever
acute inflammatory diarrhea
81
a patient with acute diarrhea with no fever, no blood/pus, you'd and healthy needs what type of treatment?
sx only
82
the major complication of portal hypertension is?
esophageal varices
83
What is the average incubation period for Hep A?
30 days
84
What is the average incubation period for Hep B and D?
6 weeks to 6 months with an average of 3 months
85
What is the average incubation period for Hep C?
2-12 weeks with 7 week average
86
What can be drained in the office/ER?
perianal abscess
87
Which symptom finding would be most concerning for perirectal abscess
rectal fullness
88
What is the appropriate abx for a patient who had an in-office
amox/clav
89
pilonidal abscessed are located?
gluteal cleft
90
acute diarrhea is?
< 2 weeks
91
most acute diarrhea is?
infectious
92
Which sx would characterize inflammatory diarrhea?
bloody
93
what is the cause of noninflammatory diarrhea
giardia
94
food left out at church
salmonella
95
daycares attendees/employees
rotavirus
96
acute diarrhea warrants work up if?
patient > 70
96
antidiarrheal agents should not be used with?
inflammatory diarrhea
97
With 5% dehydration, patients will experience?
thirst
98
severe dehydration is considered a deficit when?
less an then 10%
99
which common medication is likely to cause chronic diarrhea?
metformin
100
what is a cause of secretory diarrhea?
zollinger ellison syndrome
101
in chronic diarrhea, which condition will exhibit increased fecal fat?
pancreatic insufficiency
102
in the liver disease spectrum, what is most advanced?
cirrhosis
103
Hep A transmission
fecal-oral
104
does Hep A typically cause chronic liver disease?
no
105
Hep B transmission
sexual contact
106
What age group is most likely to get Hep B?
infants
107
When is the first dose of Hep B vaccine given?
just after birth
108
about 50% of new Hep C cases are associated with?
IV drug use
109
Is there a vaccine for Hep C
no
110
an accumulation of what causes hepatic encephalopathy
ammonia
111
the only definitive tx for acute liver failure is
liver transplant
112
the mortality rate of acute liver failure with severe encephalopathy
80%
113
the first stage of alcoholic liver disease is?
steatosis
114
NASH is associated with?
insulin resistance
115
which class of medications is most likely to cause liver injury?
antimircrobials
115
hemochromatosis
autosomal recessive
116
hemochromatosis is a buildup of _____ in the liver
iron
117
Wilson's is a build-up of what in the liver
copper
118
post hepatic obstruction of blood flow?
budd chiari syndrome
119
treatment for budd chiari syndrome
LMWH
120
cancer marker for hepatocellular carcinoma
alpha fetoprotein
121
biliary colic pain occurs in the
RUQ
122
what test looks at the gallbladder function?
HIDA scan
123
treatment for biliary colic
avoid trigger food
123
when a gallstone gets impacted in the cystic duct, it is called
acute cholecystitis
124
inflammation of the biliary tree due to infection
ascending cholangitis
125
mostly effects males with IBD, may have genetic and/or autoimmune links
primary sclerosing cholangitis
125
most common cause of pancreatitis
gallstones
126
pain with pancreatitis
epigastric
127
superficial edema and bruising in the subcutaneous fatty tissue
pancreatitis, Cullen sign
128
most common cause of chronic pancreatitis
alcohol
129
T or F: serum amylase/lipase elevated in chronic pancreatitis
false
130
most common cause of pancreatic cancer
adenocarcinoma
131
most pancreatic cancers are where?
head of the pancreas
132
early pancreatitis tends to be
painless
133
what is the surgery for pancreatic cancer
whipple
134
what is the survival rate for pancreatitis
bad
135
what is the leading cause of childhood blindness worldwide?
Vit A deficiency
136
leading cause of childhood blindness worldwide
Vit A
136
Vit D helps with?
bone mineralization
136
nystagmus, ataxia, confusion
Wernicke, thiamine
137
swollen, bleeding gums, easy brusiing, brittle hair, and slow healing
Vit C deficiency
138
impaired ability to digest a sugar found in milk and other dairy
lactase deficiency
139
What is esophagitis?
Esophagitis is the inflammation of the esophagus.
140
What are the two types of esophagitis?
The two types of esophagitis are infectious (fungal or viral) and noninfectious (GERD, medications, eosinophilia).
141
What is GERD?
GERD is a condition where the lower esophageal sphincter relaxes or there is increased abdominal pressure.
142
Who is most commonly affected by GERD?
Women aged 30-60 years old are most commonly affected by GERD.
143
What are the major symptoms of GERD?
The major symptoms of GERD include heartburn and regurgitation.
144
What are the diagnostics for GERD?
Diagnostics for GERD include upper endoscopy with potential biopsy and possibly pH monitoring if nothing is found on the scope.
145
What are some treatments for GERD?
Treatments for GERD include lifestyle modifications, antacids, H2 blockers like Pepcid, and PPIs.
146
What complications can arise from GERD?
Patients can develop chronic laryngitis, hoarseness, or asthma.
147
What is Barrett's Esophagus?
Barrett's Esophagus is a condition where there is metaplasia from squamous epithelium to columnar epithelium.
148
What causes Barrett's Esophagus?
Barrett's Esophagus is caused by long-standing GERD and can lead to adenocarcinoma.
149
What are the diagnostics for Barrett's Esophagus?
Diagnostics for Barrett's Esophagus include upper endoscopy and biopsy (EGD).
150
What is the treatment for Barrett's Esophagus?
The treatment for Barrett's Esophagus involves treating GERD and monitoring with endoscopy every 6 months to 3 years.
151
What is Erosive Esophagitis?
Immunocompromised people typically present with substernal chest pain and thrush.
152
What is the gold standard diagnostic for Erosive Esophagitis?
Endoscopy with biopsy is diagnostic and the gold standard.
153
What should be tested for in Erosive Esophagitis if HIV status is unknown?
Always test for HIV.
154
What is the treatment for Candida in Erosive Esophagitis?
Fluconazole PO.
155
What is the treatment for CMV in Erosive Esophagitis?
Ganciclovir.
156
What is the treatment for Herpes in Erosive Esophagitis?
Antivirals.
157
What causes Medication Induced Esophagitis?
Most often caused by medications like bisphosphonates, doxycycline, clindamycin, NSAIDs, and Bactrim.
158
What is the diagnostic method for Medication Induced Esophagitis?
Endoscopy, but avoid in patients with dysmotility and tears.
159
What is the treatment for Medication Induced Esophagitis?
Take pills with water and sit upright for 30 minutes after.
160
What is Eosinophilic Esophagitis?
Chronic immune and antigen-mediated inflammation. Consider in patients unresponsive to GERD therapy.
161
What is the diagnostic method for Eosinophilic Esophagitis?
Endoscopy to look for linear furrows and esophageal rings.
162
What is the first-line treatment for Eosinophilic Esophagitis?
PPIs and steroids.
163
What are the second-line treatments for Eosinophilic Esophagitis?
Elimination diet and esophageal dilation.
164
What is Mallory-Weiss Syndrome?
Longitudinal mucosal lacerations associated with forced retching and vomiting at the GE junction.
165
In which patients is Mallory-Weiss Syndrome most often considered?
Most often in bulimia and alcoholics.
166
What are the possible symptoms of Mallory-Weiss Syndrome?
May have melena, and hiatal hernias are predisposing factors.
167
What are the diagnostics for Mallory-Weiss Syndrome?
Endoscopy, CBC, type and screen.
168
What is the treatment for Mallory-Weiss Syndrome?
Fluid restriction, blood transfusions, may inject with API or clip the artery if still bleeding.
169
What are esophageal varices?
Patients with portal hypertension experiencing severe, painless upper GI bleeding and hemorrhagic shock.
170
What is the diagnostic method for esophageal varices?
Emergent endoscopy. Will need type and screen and coag studies.
171
What is the treatment for esophageal varices?
Fluid resuscitation, blood transfusions, Ocreotide, Vitamin K, endoscopy.
172
How often should cirrhosis patients be screened for esophageal varices?
Endoscopy every 3 years.
173
What medication is used to prevent bleeding in esophageal varices?
Beta blocker.
174
What is achalasia?
Decreased peristalsis of the upper esophagus and increased muscle tone of the lower esophagus leading to dilation of the LES.
175
What are the symptoms of achalasia?
Progressive dysphagia to solids and liquids.
176
What diagnostic test shows a 'birds beak' or 'rat tail' appearance for achalasia?
Barium swallow.
177
What are the treatment options for achalasia?
Botulinum toxin, balloon dilation, surgery.
178
What is the risk associated with achalasia?
Greater risk for squamous cell and adenocarcinoma.
179
What characterizes obstructive disorders of the esophagus?
Gradual dysphagia for solids.
180
What are common causes of obstructive disorders of the esophagus?
Esophageal ring or Schatzki ring (most common at the GE junction), esophageal webs, strictures/stenosis caused by GERD.
181
What are Esophageal Neoplasms?
Esophageal Neoplasms develop over weeks and cause progressive dysphagia to solids. They are seen more often in men. Adenocarcinoma is the most common type and is typically a complication of Barrett's esophagus.
182
What are the risk factors for Esophageal Neoplasms?
Risk factors include smoking, tobacco use, GERD, and Barrett's esophagus.
183
What are the diagnostics for Esophageal Neoplasms?
Diagnostics include endoscopy and biopsy, as well as CT/PET scans.
184
What are the treatment options for Esophageal Neoplasms?
Treatment options include chemotherapy, radiation, and surgery. In 2011, the 5-year survival rate was reported.
185
What is Gastritis?
Gastritis is the inflammation of the mucosal lining of the stomach.
186
What is Erosive/Hemorrhagic gastritis and its causes?
Erosive/Hemorrhagic gastritis is caused by NSAIDs, alcohol, and stress.
187
What are the symptoms of Erosive/Hemorrhagic gastritis?
Symptoms include GI bleeding, hematemesis or coffee ground emesis, and epigastric tenderness.
188
What are the diagnostics for Erosive/Hemorrhagic gastritis?
Diagnostics include endoscopy and may reveal iron deficiency anemia.
189
What is the treatment for Erosive/Hemorrhagic gastritis?
Treatment involves stopping NSAIDs and starting a trial of PPIs for 2-4 weeks. If no improvement is seen, perform endoscopy. Alcohol should be stopped, and a trial of H2 receptor antagonists, PPIs, or sucralfate for 2-4 weeks should be initiated. If no improvement, do endoscopy. For stress-induced gastritis, PPIs are recommended.
190
What should be done for active bleeding in Erosive/Hemorrhagic gastritis?
For active bleeding, a PPI should be administered.
191
How is H pylori infection spread?
H pylori infection can be spread by fecal-oral route or oral-to-oral route.
192
What allows H pylori to colonize the stomach?
Gastric curious allows the organism to colonize the acidic stomach and serves as a biomarker for the presence of H pylori.
193
What are common symptoms of H pylori infection?
Good-like symptoms and mild epigastric tenderness.
194
What is the most common type of gastritis affected by H pylori?
It affects the antrum of the stomach.
195
What is decreased in H pylori infection?
Decreased somatostatin (delta cells).
196
What are the diagnostic tests for H pylori infection?
1. Serum antibody test 2. Fecal antigen immunoassay 3. Urea breath test 4. Endoscopy and biopsy.
197
What is the treatment for H pylori infection?
Quadruple therapy includes a PPI, Bismuth, tetracycline, and metronidazole.
198
What characterizes gastric ulcers?
Gastric ulcers extend through the muscularis and are usually over 5 mm.
199
What symptoms do gastric ulcers cause?
They cause epigastric pain one to two hours after eating, described as gnawing or hunger-like pain.
200
What happens if a gastric ulcer is perforated?
It leads to peritonitis with irritation of the peritoneum by leakage of hydrochloric acid, blood, or fecal matter.
201
What is a common symptom of gastric ulcers?
Patients typically have coffee ground emesis.
202
What are the diagnostic tests for gastric ulcers?
Fecal occult blood testing, pyloric testing, and endoscopy with biopsy.
203
What is the treatment for gastric ulcers?
1. PPI 2. Sucralfate, antacids, misoprostol.
204
What are complications of gastric ulcers?
G.I. hemorrhage and perforation.
205
What is Zollinger-Ellison syndrome?
A gastric secreting neuroendocrine tumor that leads to increased gastrin and peptic ulcer disease (PUD).
206
What characterizes the onset of Zollinger-Ellison syndrome?
Sudden onset that is not related to eating.
207
What is the test of choice for Zollinger-Ellison syndrome diagnosis?
Increased serum fasting gastrin.
208
What is another test for Zollinger-Ellison syndrome?
The secretin stimulation test.
209
What is the treatment for Zollinger-Ellison syndrome?
Resection if possible; if not, a PPI, chemotherapy, and radiation are indicated.
210
What is gastric carcinoma?
Gastric carcinoma is the most common cancer that develops from the glandular cells of the stomach.
211
Where are the most common sites for gastric carcinoma?
The most common sites are the antrum and cardia of the stomach.
212
What are the risk factors for gastric carcinoma?
Risk factors include dietary salt, food preservation, male gender, and family history.
213
What are the symptoms of gastric carcinoma?
New onset dyspepsia in patients over 55 years old.
214
What is the Sister Mary Joseph sign?
The Sister Mary Joseph sign indicates hard periumbilical lymph nodes.
215
What are the diagnostic methods for gastric carcinoma?
Diagnostics include endoscopy with biopsy, CT, or PET for evaluation of metastasis.
216
What is the treatment for gastric carcinoma?
Treatment includes surgery, chemotherapy, and radiation.
217
What is PUD and its common causes?
PUD (Peptic Ulcer Disease) is more common than gastric ulcers, with H. pylori and NSAIDs as the most common causes.
218
What symptom relief is associated with PUD?
Pain is relieved with food and may awaken the patient at night.
219
What are the diagnostic methods for PUD?
Diagnostics include fecal occult blood testing, H. pylori testing, and endoscopy with biopsy.
220
What is the first line treatment for PUD?
The first line treatment includes PPIs (Proton Pump Inhibitors) and H2 blockers.
221
What is the second line treatment for PUD?
The second line treatment includes agents that may help the mucosal lining, such as sucralfate, antacids, and misoprostol.
222
What is vagotomy?
Vagotomy is the surgical ligation of the vagus nerve to decrease gastric acid secretion.
223
What is pyloroplasty?
Pyloroplasty is the surgical dilation of the pyloric sphincter to increase the rate of gastric emptying.
224
What is antrectomy?
Antrectomy involves removing the antrum of the stomach, which produces a lot of acid.
225
What are the symptoms of appendicitis?
Pain comes with movement, typically starting as periumbilical pain that intensifies to the right upper quadrant.
226
What is the most common demographic for appendicitis?
Most common in Caucasian males between 10 to 30 years old.
227
What are the physical signs of appendicitis?
Physical signs include Rovsing's sign, obturator sign, psoas sign, and tenderness at McBurney's point.
228
What is the diagnostic test of choice for appendicitis in adults?
CT with contrast is the test of choice in adults.
229
What is the diagnostic test of choice for appendicitis in children?
Ultrasound is preferred in children if the appendix is over 6 mm.
230
What are the lab findings associated with appendicitis?
White blood cell count typically shows 85% neutrophils predominant.
231
What is the treatment for appendicitis?
Treatment includes pain control and potential appendectomy with preoperative antibiotics.
232
What are the complications of untreated appendicitis?
Complications include perforation, which is high risk if not treated within 36 hours of onset.
233
What is the most common surgical disorder of the small intestine?
Obstruction of the small intestine is the most common surgical disorder.
234
Where is small intestine obstruction most common?
Most common in the ileum and proximal jejunum.
235
What is gastric carcinoma?
Gastric carcinoma is the most common cancer that develops from the glandular cells of the stomach.
236
Where are the most common sites for gastric carcinoma?
The most common sites are the antrum and cardia of the stomach.
237
What are the risk factors for gastric carcinoma?
Risk factors include dietary salt, food preservation, male gender, and family history.
238
What are the symptoms of gastric carcinoma?
New onset dyspepsia in patients over 55 years old.
239
What is the Sister Mary Joseph sign?
The Sister Mary Joseph sign indicates hard periumbilical lymph nodes.
240
What are the diagnostic methods for gastric carcinoma?
Diagnostics include endoscopy with biopsy, CT, or PET for evaluation of metastasis.
241
What is the treatment for gastric carcinoma?
Treatment includes surgery, chemotherapy, and radiation.
242
What is PUD and its common causes?
PUD (Peptic Ulcer Disease) is more common than gastric ulcers, with H. pylori and NSAIDs as the most common causes.
243
What symptom relief is associated with PUD?
Pain is relieved with food and may awaken the patient at night.
244
What are the diagnostic methods for PUD?
Diagnostics include fecal occult blood testing, H. pylori testing, and endoscopy with biopsy.
245
What is the first line treatment for PUD?
The first line treatment includes PPIs (Proton Pump Inhibitors) and H2 blockers.
246
What is the second line treatment for PUD?
The second line treatment includes agents that may help the mucosal lining, such as sucralfate, antacids, and misoprostol.
247
What is vagotomy?
Vagotomy is the surgical ligation of the vagus nerve to decrease gastric acid secretion.
248
What is pyloroplasty?
Pyloroplasty is the surgical dilation of the pyloric sphincter to increase the rate of gastric emptying.
249
What is antrectomy?
Antrectomy involves removing the antrum of the stomach, which produces a lot of acid.
250
What are the symptoms of appendicitis?
Pain comes with movement, typically starting as periumbilical pain that intensifies to the right upper quadrant.
251
What is the most common demographic for appendicitis?
Most common in Caucasian males between 10 to 30 years old.
252
What are the physical signs of appendicitis?
Physical signs include Rovsing's sign, obturator sign, psoas sign, and tenderness at McBurney's point.
253
What is the diagnostic test of choice for appendicitis in adults?
CT with contrast is the test of choice in adults.
254
What is the diagnostic test of choice for appendicitis in children?
Ultrasound is preferred in children if the appendix is over 6 mm.
255
What are the lab findings associated with appendicitis?
White blood cell count typically shows 85% neutrophils predominant.
256
What is the treatment for appendicitis?
Treatment includes pain control and potential appendectomy with preoperative antibiotics.
257
What are the complications of untreated appendicitis?
Complications include perforation, which is high risk if not treated within 36 hours of onset.
258
What is the most common surgical disorder of the small intestine?
Obstruction of the small intestine is the most common surgical disorder.
259
Where is small intestine obstruction most common?
Most common in the ileum and proximal jejunum.
260
What are polyps of the small intestine?
Most polyps in the SI are benign. Adenomatous polyps have the potential to become malignant. Complications include obstruction and bleeding.
261
What is the mean age at diagnosis for small bowel neoplasms?
Mean age at diagnosis is 65.
262
What are the risk factors for small bowel neoplasms?
Risk factors include familial cancer syndrome (familial adenomatous polyposis), male gender, age >60, celiac disease, and Crohn’s Disease.
263
What are the symptoms of small bowel neoplasms?
Symptoms include abdominal pain, weight loss, nausea/vomiting, obstruction, and GI bleeding.
264
What are the diagnostics for small bowel neoplasms?
Diagnostics include barium swallow, CT, and surgery with biopsy/resection.
265
What is the treatment for small bowel neoplasms?
Treatment includes surgical resection and chemotherapy.
266
What is celiac disease?
Celiac disease is a chronic dietary disorder caused by an immune response to gluten.
267
What is dermatitis herpetiformis?
Dermatitis herpetiformis is a cutaneous variant of celiac disease (<10%).
268
What are the risk factors for celiac disease?
Risk factors include being female, having diabetes, and a family history of the disease.
269
What is the pathophysiology of celiac disease?
The pathophysiology involves an immune response that causes inflammation.
270
What are the symptoms of celiac disease?
Symptoms include diarrhea, steatorrhea, weight loss, abdominal distension, growth retardation (in children), and muscle wasting.
271
What are atypical symptoms of celiac disease in adults?
Atypical symptoms include fatigue, depression, anemia, amenorrhea, and decreased fertility.
272
What are the physical exam findings in celiac disease?
Physical exam may be normal; in severe cases, findings include malabsorption, loss of muscle mass, subcutaneous fat, pallor, easy bruising, and distension with hypoactive bowel sounds.
273
What is the recommended diagnostic test for celiac disease?
The IgA tissue transglutaminase (IgA tTG) antibody test is recommended, with 95% sensitivity and specificity.
274
What is the treatment for celiac disease?
Treatment involves removing all gluten from the diet and providing supplements as needed (folate, iron, B12). TPN may be needed for severe malnutrition.
275
What is acute mesenteric ischemia?
Acute mesenteric ischemia is caused by thromboembolic occlusion of mesenteric arteries, mesenteric venous thrombosis, or aortic dissection.
276
What are the risk factors for acute mesenteric ischemia?
Atrial fibrillation is a significant risk factor.
277
What are the symptoms of acute mesenteric ischemia?
Symptoms include severe abdominal pain out of proportion to physical exam findings and abdominal pain followed by forceful bowel evacuation.
278
What is the diagnostic test of choice for acute mesenteric ischemia?
CT angiography is the test of choice for this diagnosis.
279
What is the treatment for acute mesenteric ischemia?
Treatment includes emergent revascularization, surgical resection of necrotic bowel, broad-spectrum antibiotics, volume resuscitation, and anticoagulation.
280
What is diverticular disease?
Diverticular disease can occur in the large or small bowel, most commonly in the sigmoid colon.
281
What is diverticulitis?
Diverticulitis is the inflammation and/or infection of a diverticula.
282
What are the risk factors for diverticular disease?
Risk factors include age (median age is 62), obesity, lack of exercise, lack of fiber, and NSAID/ASA use.
283
What are the symptoms of diverticulitis?
Symptoms include abdominal pain, fever, constipation, nausea/vomiting/diarrhea, dysuria, anorexia, and rectal bleeding.
284
What are the physical exam findings in diverticulitis?
Findings may include fever, LLQ tenderness, palpable mass, distension, and blood on rectal exam.
285
What is the diagnostic test for diverticulitis?
CT of the abdomen and pelvis with IV contrast is the diagnostic test.
286
What is the treatment for mild diverticulitis?
Outpatient management may not require antibiotics if asymptomatic; a clear liquid diet is recommended.
287
What is the treatment for moderate diverticulitis?
Management includes bowel rest, IV fluids, and IV antibiotics.
288
What are the indications for surgery in diverticulitis?
Indications include generalized peritonitis, large abscesses that cannot be drained, and clinical deterioration despite medical management.
289
What is Crohn's disease?
Crohn's disease is a chronic inflammatory condition of the GI tract.
290
What is the onset age for Crohn's disease?
Onset typically occurs between 10-30 years of age, with a higher prevalence in women.
291
What is the pathophysiology of Crohn's disease?
It can affect any segment of the GI tract, most commonly the terminal ileum, and is characterized by skip lesions and transmural lesions.
292
What are the symptoms of Crohn's disease?
Symptoms include intermittent low-grade fever, diarrhea, RLQ pain, malaise, and non-bloody diarrhea.
293
What are the physical exam findings in Crohn's disease?
Findings may include RLQ tenderness/mass and perianal disease.
294
What is the diagnostic test for Crohn's disease?
Fecal calprotectin is an excellent noninvasive test correlated with active inflammation.
295
What is the treatment for Crohn's disease?
Maintenance treatment includes mesalamine, sulfasalazine, immune-modifying agents, and anti-TNF agents; corticosteroids are used for acute flares.
296
What is ulcerative colitis?
Ulcerative colitis is an inflammatory condition of the mucosal surface of the rectum and colon.
297
What is the pathophysiology of ulcerative colitis?
The exact cause is unknown, but it involves changes in intestinal flora and immune responses.
298
What are the symptoms of ulcerative colitis?
Symptoms include frequent bloody diarrhea, cramps, abdominal pain, fecal urgency, and tenesmus.
299
What are the physical exam findings in ulcerative colitis?
Findings may include tenderness, especially in the LLQ, and bright red blood on rectal exam.
300
What is the treatment for ulcerative colitis?
For maintenance, mesalamine, sulfasalazine, and anti-TNF agents are used; corticosteroids are for acute flares.
301
What is irritable bowel syndrome (IBS)?
IBS is an idiopathic GI disorder characterized by abdominal pain or discomfort associated with altered bowel habits.
302
What are the subtypes of IBS?
IBS can be classified as IBS with constipation, IBS with diarrhea, or mixed type.
303
What are the risk factors for IBS?
Risk factors include depression, anxiety, migraines, and fibromyalgia.
304
What are the symptoms of IBS?
Symptoms include bloating, changes in stool frequency, and abdominal pain.
305
What are the diagnostic criteria for IBS?
Diagnosis is based on clinical history and absence of alarm symptoms.
306
What are alarm features for IBS?
Alarm features include age >60 with new bowel habits, unexplained weight loss, rectal bleeding, and family history of cancer.
307
What is the treatment for IBS?
Treatment includes antispasmodics, SSRIs, antidiarrheals, fiber supplements, and dietary restrictions.
308
What is antibiotic-associated colitis?
Antibiotic-associated colitis is a life-threatening condition caused by C. difficile.
309
How is C. difficile transmitted?
Transmission typically occurs via the fecal-oral route or contaminated surfaces.
310
What is the pathophysiology of antibiotic-associated colitis?
C. difficile overgrowth occurs after antibiotics disrupt normal gut flora, leading to toxin production and mucosal damage.
311
What are the symptoms of antibiotic-associated colitis?
Symptoms include copious diarrhea, which may contain mucus.
312
What are the diagnostic tests for antibiotic-associated colitis?
Diagnostic options include glutamate dehydrogenase assay, enzyme immunoassays, and nucleic acid amplification tests.
313
What is the standard treatment for antibiotic-associated colitis?
Standard treatment includes oral vancomycin; severe cases may require IV metronidazole.
314
What is fecal microbiota transplantation (FMT)?
FMT is an emerging therapy for recurrent C. difficile infection, showing high cure rates.
315
What are the prevention strategies for antibiotic-associated colitis?
Prevention includes antibiotic stewardship, infection control, hand washing, and probiotics.
316
What is Toxic Megacolon?
Toxic colitis with dilation of the colon.
317
What are the diagnostic criteria for Toxic Megacolon?
Radiographic evidence of colonic dilatation (more than 6 cm in the transverse colon) and any 3 of the following: fever (>101.5), tachycardia (>120), leukocytosis (>10.5 x 10^3) or anemia, and any 1 of the following: dehydration, AMS, electrolyte abnormality, or hypotension.
318
What is Ischemic Colitis?
Inflammation/ischemia of the colon resulting from a lack of blood flow.
319
What are common precipitating events for Ischemic Colitis?
Hypotension, MI, sepsis, heart failure, cardiac or aortic surgery, cocaine.
320
What are the symptoms of Ischemic Colitis?
Tenderness over the affected area, increasing abdominal tenderness, guarding, rebound tenderness, and abdominal distention.
321
How is Ischemic Colitis diagnosed?
CT scan may show segmental circumferential wall thickening or be normal; colonoscopy is used to confirm.
322
What is the treatment for Ischemic Colitis?
Bowel resection if peritoneal signs, symptoms persist > 2 weeks, or severe complications.
323
What are the common causes of Large Bowel Obstruction?
Carcinoma of colon (65% incidence), diverticulitis (20%), volvulus (5%), and miscellaneous causes (10%).
324
What are Large Intestine Polyps?
Growths that arise from the epithelial cells lining the colon, with adenomatous polyps placing patients at higher risk of cancer.
325
What are the risk factors for adenomatous polyps?
Older age, family history, high animal fat/red meat diet, ulcerative colitis, excess body weight, and moderate to heavy alcohol consumption.
326
What are the symptoms of colon polyps?
Usually asymptomatic; may experience overt or occult rectal bleeding and change in bowel habits.
327
How are colon polyps diagnosed?
Identified on barium enema or colonoscopy; colonoscopy is performed to remove the polyp.
328
What is Familial Adenomatous Polyposis?
Inherited condition characterized by early development of hundreds to thousands of colonic adenomatous polyps and adenocarcinoma.
329
What is the recommended treatment for Familial Adenomatous Polyposis?
Prophylactic colectomy to prevent colon cancer.
330
What is the most common type of Colorectal Cancer?
Almost always adenocarcinomas (90%) originating from the epithelial cells of the colorectal mucosa.
331
What are the risk factors for Colorectal Cancer?
Age, family history, IBD, high meat/low fiber diet.
332
At what age should everyone be screened for Colorectal Cancer?
At age 45.
333
What are the primary symptoms of Colorectal Cancer?
Painless rectal bleeding, occult blood in stool, and change in bowel habits.
334
What diagnostics are used for Colorectal Cancer?
Carcinoembryonic antigen (CEA) monitoring, colonoscopy for diagnosis and biopsy/staging, and CT or MRI for staging.
335
What is the treatment for Colorectal Cancer?
Surgery for resection of cancer and regional lymph node removal, chemotherapy, and treatment depends on TNM staging.
336
What is Constipation?
Persistent, difficult, infrequent, or seemingly incomplete defecation.
337
What are some treatments for Constipation?
Fiber (psyllium, bran), stool surfactants (docusate sodium, mineral oil), osmotic laxatives (PEG, magnesium hydroxide), stimulant laxatives (Senna), and enemas.
338
What is Fecal Impaction?
A severe bowel condition where a hard, dry mass of stool becomes stuck in the colon or rectum.
339
How is Fecal Impaction diagnosed?
Must perform a rectal exam.
340
What are Hemorrhoids?
Dilation of blood vessels, can be internal (above the dentate line) or external (below the dentate line).
341
What are the symptoms of Hemorrhoids?
Bright red blood after bowel movement, internal hemorrhoids are usually painless, external hemorrhoids are painful.
342
What is the initial treatment for Hemorrhoids?
Conservative measures like increasing fiber and fluid intake, behavior modifications, and comfort measures.
343
What are some procedures for treating Hemorrhoids?
Excision of thrombosed hemorrhoids, rubber band ligation, sclerotherapy, and hemorrhoidectomy for extreme cases.
344
What is an anal fissure?
A linear fissure, usually < 5 cm, most commonly occurring in the posterior midline, arising from trauma during defecation.
345
What symptoms do patients with anal fissures report?
Patients report a tearing sensation, bright red blood, and significant pain.
346
How are anal fissures diagnosed?
Diagnosis is made through inspection.
347
What is the treatment for anal fissures?
Treated topically, with stool softeners and increased fiber.
348
What are the types of anorectal abscesses?
Types include perianal, perirectal, ischiorectal, intersphincteric, and supralevator abscesses.
349
What symptoms are associated with anorectal abscesses?
Symptoms include pain associated with abscess and/or fistula, necessitating careful rectal exam.
350
How are anorectal abscesses diagnosed?
CT is used to evaluate the extent of the abscess; MRI may be needed to track fistula.
351
What is the treatment for perirectal abscesses?
All perirectal abscesses should be drained in the operating room.
352
How are simple perianal abscesses treated?
They may be drained in the ED or office (general surgery).
353
What antibiotics are used for perianal abscesses treated as outpatient?
Augmentin or Cipro/Flagyl.
354
What antibiotics are used for perirectal abscesses?
IV antibiotics, broad spectrum such as Zosyn or Invanz.
355
What is a pilonidal cyst?
An acquired problem formed by the penetration of the skin by an ingrown hair, causing a foreign body granuloma reaction.
356
What is the treatment for a pilonidal cyst?
Incision and drainage (I&D); antibiotics are needed only if cellulitis is present.
357
What is acute diarrhea?
Increased stool frequency or liquid stools lasting < 2 weeks.
358
What are the causes of acute diarrhea?
More than 90% are caused by infectious agents, often with vomiting, fever, and abdominal pain.
359
What are the types of acute diarrhea?
Acute noninflammatory diarrhea and acute inflammatory diarrhea.
360
What causes acute noninflammatory diarrhea?
Caused by a virus or noninvasive bacteria.
361
What are examples of viral causes of acute diarrhea?
Rotavirus, norovirus, adenovirus.
362
What are examples of toxin-producing bacteria causing acute diarrhea?
E. coli, Staph aureus, Clostridium perfringens.
363
What are examples of parasitic causes of acute diarrhea?
Giardia.
364
What characterizes acute inflammatory diarrhea?
Presence of blood or pus, fever, usually caused by an invasive or toxin-producing bacterium.
365
What diagnostic evaluation is required for acute inflammatory diarrhea?
Routine stool bacterial testing and testing for C. diff toxin, ova, and parasites.
366
What are at-risk groups for acute diarrhea?
Travelers, campers, consumers of certain foods.
367
What is the treatment for acute diarrhea?
Oral rehydration, antidiarrheal agents unless bloody, and empiric antibiotics if indicated.
368
What are the causes of chronic diarrhea?
Medications, osmotic diarrhea, secretory conditions, inflammatory conditions, IBS, chronic infections.
369
What is cirrhosis?
The end result of injury leading to fibrosis and regenerative nodules, may be reversible if the cause is removed.
370
What are the causes of cirrhosis?
Chronic viral hepatitis, alcohol, drug toxicity, autoimmune and metabolic liver diseases.
371
What are the symptoms of cirrhosis?
Jaundice, ascites, hepatomegaly, signs of portal hypertension.
372
What is the diagnostic evaluation for cirrhosis?
Liver function tests, CBC, prolonged PT/INR, ammonia levels, imaging.
373
What is portal hypertension?
Increased pressure in the portal venous system, commonly a complication of cirrhosis.
374
What are the major complications of portal hypertension?
Esophageal varices.
375
How is portal hypertension diagnosed?
Direct measurement via catheterization or less invasive tests like endoscopy and Doppler US.
376
What is the treatment for portal hypertension?
Treat underlying cause, endoscopy for bleeding varices, prophylaxis with beta blockers.
377
What is Hepatitis A?
A viral infection transmitted via fecal-oral route, leading to liver cirrhosis and failure.
378
What are the symptoms of Hepatitis A?
Mild abdominal pain, jaundice, defervescence coinciding with jaundice onset.
379
What is the diagnostic test for Hepatitis A?
HAV total antibody, HAV IgM antibody for acute infection, and HAV IgG antibody for immunity.
380
What is the treatment for Hepatitis A?
Symptomatic treatment, avoid liver toxic medications and alcohol.
381
What is the vaccination schedule for Hepatitis A in children?
Recommended at age 1 year, given as a two-dose series.
382
What is Hepatitis B?
A viral infection that can be acute or chronic, transmitted via infected blood or sexual contact.
383
What are the symptoms of Hepatitis B?
Fatigue, fever, RUQ pain, jaundice, dark urine, hepatomegaly.
384
What is the treatment for Hepatitis B?
Symptomatic treatment, avoid hepatotoxic substances, antiviral treatment for hepatic failure.
385
What is the vaccination schedule for Hepatitis B?
A series of 3 doses, starting at birth.
386
What are the risk factors for Hepatitis C (Hep C)?
IVDU, intranasal drug use, long term dialysis, healthcare workers, recipients of blood products/organ transplants before 1992, unregulated tattoos.
387
What is the incubation period for Hep C?
2-12 weeks (7 week average).
388
How is Hep C primarily transmitted?
Usually transmitted by IVDU (50% of the time).
389
What is the common coinfection with Hep C?
Coinfection with HIV is common (25% of people with HIV also have HCV).
390
What is the pathophysiology of Hep C?
15% resolve. If not treated, 20% chance of developing cirrhosis, 4% will eventually turn into liver cancer.
391
How many genomes and subtypes does HCV have?
6 genomes with several subtypes of each.
392
What are the symptoms of Hep C?
Clay colored stools.
393
What are the physical exam findings in Hep C?
May have jaundice or RUQ tenderness.
394
What is the diagnosis for Hep C?
Elevated liver enzymes (AST/ALT).
395
What tests are used for diagnosing acute Hep C infection?
HCV RNA: viral load tests for acute infection.
396
When do Anti-HCV antibodies become positive?
Positive about 12 weeks after infection and will always remain positive.
397
What is the treatment for Hep C?
Direct acting antiviral agents for 6 weeks has been shown to decrease the chance of it progressing to chronic HIV.
398
How effective are antiviral treatments for Hep C?
Can cure about 90% of people in 8-12 weeks and the virus remains undetectable.
399
Is there a vaccine for Hep C?
There is no immunity for Hep C. NO VACCINE AVAILABLE.
400
What is Hep D's relationship with Hep B?
Can only coinfect with Hep B. Rare in the US since Hep B is relatively well controlled.
401
What is the risk of hepatocellular carcinoma in patients with chronic Hep B and Hep D?
3x risk of hepatocellular carcinoma.
402
How should Hep D be diagnosed?
All patients with Acute or Chronic Hep B should be tested for Hep D.
403
What is Hep E known for?
A major cause of acute hepatitis throughout central and southeast Asia, the Middle East, and North Africa.
404
What should be considered in patients with acute hepatitis after a trip to an endemic area?
Hep E.
405
How is Hep E diagnosed?
Anti-HEV IgM is positive in acute hepatitis E.
406
What is the treatment for Hep E?
Self-limited.
407
What is autoimmune hepatitis?
Chronic hepatitis with high serum globulins and characteristic liver histology.
408
Who is most affected by autoimmune hepatitis?
Middle aged women.
409
What are the symptoms of autoimmune hepatitis?
May be asymptomatic. Typical initial symptoms include anorexia, fatigue, abdominal and joint pain, itching accompanying jaundice, and maculopapular rashes.
410
What is the diagnosis for autoimmune hepatitis?
Antinuclear antibody (ANA) and/or smooth muscle antibody is positive.
411
What is the treatment for autoimmune hepatitis?
Immunosuppressant therapy with corticosteroids.
412
What is Acute Liver Failure?
Development of hepatic encephalopathy within 8 weeks after acute liver injury, can progress to multiorgan failure.
413
What is the typical INR in Acute Liver Failure?
INR typically 1.5 or higher.
414
How many cases of Acute Liver Failure occur annually in the US?
1600 cases a year in the US.
415
What percentage of Acute Liver Failure cases are due to acetaminophen overdose?
45% are due to APAP (acetaminophen overdose), of which 44% are attempted suicides.
416
What are other causes of Acute Liver Failure?
Other causes include medications (abx, antifungals), viral hepatitis, malignancy, and other viruses (CMV, EBV, HSV, parvovirus B19).
417
What is the pathophysiology of hepatic encephalopathy?
AMS due to failure of the liver to metabolize ammonia to urea, disrupting glutamate and GABA neurotransmitters.
418
What symptoms should be obtained in Acute Liver Failure?
Obtain details for all prescription and non-prescription drugs, herbs, and dietary supplements.
419
What are the diagnostic criteria for Acute Liver Failure?
Severe hepatocellular damage (AST/ALT/bilirubin/alkaline phosphatase/INR elevated) and elevated serum ammonia.
420
What is the treatment for Acute Liver Failure?
Admit, placement on liver transplant list, supportive care, N-acetylcysteine for APAP toxicity, lactulose to reduce ammonia levels.
421
What are the stages of Alcoholic Liver Disease?
Stage 1: simple steatosis (fatty liver), Stage 2: alcoholic hepatitis, Stage 3: chronic hepatitis with fibrosis or cirrhosis.
422
What causes Alcoholic Liver Disease?
Alcohol metabolism signals the liver to produce more fat, causing oxidative stress.
423
What are the symptoms of Alcoholic Liver Disease?
Hepatomegaly, jaundice, abdominal pain, tenderness, splenomegaly, ascites, fever, and/or encephalopathy.
424
What is the first test for diagnosing Alcoholic Liver Disease?
Ultrasound (US) is the first test; CT/MRI may show hepatic steatosis.
425
What is the treatment for Alcoholic Liver Disease?
Abstain from alcohol, folic acid, thiamine, zinc, magnesium, corticosteroids, nutritional support.
426
What is Non-Alcoholic Fatty Liver Disease (NAFLD)?
The most common cause of elevated liver enzymes in adults in the US, associated with insulin resistance, obesity, and diabetes.
427
What can Non-Alcoholic Fatty Liver Disease progress to?
Can progress to NonAlcoholic Steatohepatitis (NASH).
428
What are the symptoms of Non-Alcoholic Fatty Liver Disease?
Asymptomatic in steatosis; fatigue, RUQ pain, jaundice, elevated liver enzymes in NASH; jaundice and ascites in cirrhosis.
429
What is the treatment for Non-Alcoholic Fatty Liver Disease?
Weight reduction, modification of cardiac risk factors, treatment of underlying condition.
430
What is Drug and Toxin Liver Injury (DILI)?
One of the leading causes of acute liver failure in the US, caused by drugs like methotrexate, acetaminophen, and antibiotics.
431
What is Hemochromatosis?
Increased accumulation of iron as hemosiderin in various organs, an autosomal recessive disease.
432
What are the symptoms of Hemochromatosis?
Cirrhosis, diabetes, skin pigmentation, though classic presentation is rare.
433
What are the diagnostic criteria for Hemochromatosis?
Mildly abnormal liver chemistries, elevated plasma iron, elevated serum ferritin, genetic testing.
434
What is the treatment for Hemochromatosis?
Phlebotomy, chelating agents, decrease iron-rich food intake, liver transplant.
435
What is Wilson's Disease?
A rare autosomal recessive disorder with excessive copper deposition in the liver and brain.
436
What are the symptoms of Wilson's Disease?
Hepatitis, splenomegaly, neurologic/psychiatric abnormalities, corneal Kayser-Fleischer ring.
437
What are the diagnostic criteria for Wilson's Disease?
Low serum ceruloplasmin, high urinary copper excretion, positive genetic test for ATP7B mutation.
438
What is the treatment for Wilson's Disease?
Goal is to attain negative copper balance; modify diet to avoid copper intake, use chelating agents.
439
What is Budd-Chiari Syndrome?
Post hepatic obstruction of blood flow, leading to impaired outflow from the liver.
440
What are the symptoms of Budd-Chiari Syndrome?
Tender, painful hepatic enlargement, often due to a hypercoagulable state.
441
What is the test of choice for diagnosing Budd-Chiari Syndrome?
Doppler ultrasound will show thrombosis and blood flow abnormalities.
442
What is the treatment for Budd-Chiari Syndrome?
Treat underlying disease, anticoagulation with LMWH, TIPS.
443
What are Liver Neoplasms/Hepatocellular carcinoma?
Typically asymptomatic but may present with jaundice, anorexia, weight loss, and abdominal pain.
444
What is the diagnostic approach for Liver Neoplasms?
CT or MRI usually shows abnormalities; US is first test, liver biopsy may be needed.
445
What is the treatment for Liver Neoplasms?
Resection if possible, liver transplant, chemotherapy.
446
What is Cholelithiasis?
Gallstones, hardened deposits of bile that form in the biliary tract.
447
What are the types of gallstones?
Cholesterol stones and pigment stones.
448
What are the symptoms of Cholelithiasis?
Most patients are asymptomatic; biliary colic may occur with RUQ pain after meals.
449
What is the test of choice for diagnosing gallstones?
RUQ ultrasound is the test of choice.
450
What is the treatment for asymptomatic gallstones?
Routine treatment not recommended; provide analgesia, avoid food/drink triggers.
451
What is Biliary Colic?
Obstruction of the cystic duct by a gallstone causing RUQ pain after eating.
452
What are the symptoms of Biliary Colic?
RUQ pain, nausea/vomiting, episodes last 15-30 mins, pain may radiate to back or shoulder.
453
What is the diagnostic approach for Biliary Colic?
RUQ ultrasound is the test of choice; HIDA scan can highlight gallbladder function.
454
What is Acute Cholecystitis?
Acute inflammation of the gallbladder most commonly associated with obstruction of the cystic duct by gallstones or biliary sludge.
455
What causes Acute Cholecystitis?
Occurs when a stone becomes impacted in the cystic duct and inflammation develops behind the obstruction.
456
What are the symptoms of Acute Cholecystitis?
Severe, episodic, epigastric or sudden RUQ pain, often radiating to the back, frequently follows food intake, and onset is often at night.
457
What is the physical examination finding in Acute Cholecystitis?
Tenderness/guarding of RUQ, palpable mass may be present after 24 hours, and a positive Murphy sign.
458
What is the Murphy sign?
Arrest of inspiration due to pain while palpating the gallbladder during deep inspiration.
459
What imaging studies are used to diagnose Acute Cholecystitis?
HIDA scan and RUQ abdominal ultrasound are used, with ultrasound being the first choice.
460
What are the diagnostic criteria for Acute Cholecystitis on ultrasound?
Gallbladder wall thickening >3mm, pericholecystic fluid, positive Murphy sign, and gallstones.
461
What is the initial treatment for Acute Cholecystitis?
Includes NPO, IV fluids, electrolyte correction, antibiotics, and analgesics.
462
What is the definitive treatment for Acute Cholecystitis?
Cholecystectomy, generally laparoscopic, should be performed within 24 hours after admission.
463
What is Choledocholithiasis?
Obstruction of the common bile duct, usually due to bile duct stones originating from the gallbladder.
464
What are the symptoms of Choledocholithiasis?
Pain similar to biliary colic but lasts longer (>5 hours).
465
What is the Courvoisier sign?
A palpable gallbladder due to common bile duct obstruction.
466
What is the gold standard for diagnosing Ascending Cholangitis?
An ultrasound, CT, or ERCP may show a dilated common bile duct.
467
What is the classic symptom triad of Ascending Cholangitis?
Charcot triad: high fever, RUQ abdominal pain, and jaundice.
468
What is Primary Sclerosing Cholangitis?
A chronic liver disease characterized by inflammation, destruction, and narrowing of the bile ducts.
469
What is the diagnostic imaging for Primary Sclerosing Cholangitis?
MRCP shows characteristic beaded segmental fibrosis of the bile ducts.
470
What is the only therapy shown to prolong survival in Primary Sclerosing Cholangitis?
Liver transplant.
471
What is Acute Pancreatitis?
A condition where premature activation of pancreatic enzymes leads to autodigestion of pancreatic tissue.
472
What are the symptoms of Acute Pancreatitis?
Severe, steady epigastric pain that may radiate, worsened by eating, and tenderness in the epigastric region.
473
What are Cullen's and Grey Turner signs?
Cullen’s sign: superficial edema and bruising around the umbilicus; Grey Turner sign: ecchymosis of the lateral abdominal wall.
474
What is the main diagnostic test for Acute Pancreatitis?
Lipase is better for diagnosis than amylase.
475
What is the treatment for Acute Pancreatitis?
Aggressive IV hydration, NPO, pain management, and removal of gallstones.
476
What is Chronic Pancreatitis?
A progressive disorder characterized by irreversible fibrosis of the pancreas leading to exocrine and endocrine failure.
477
What are the risk factors for Chronic Pancreatitis?
Alcohol consumption, genetic factors, autoimmune diseases, and inflammatory bowel disease.
478
What are the symptoms of Chronic Pancreatitis?
Steatorrhea in later stages, chronic epigastric and LUQ pain, often described as gnawing or burning.
479
What is Pancreatic Insufficiency?
A syndrome of maldigestion due to partial or complete loss of pancreatic enzyme activity.
480
What are the symptoms of Pancreatic Insufficiency?
Weight loss, steatorrhea, abdominal cramps, and signs of malabsorption.
481
What are Pancreatic Neoplasms?
Can be endocrine or exocrine, with exocrine being more common, particularly adenocarcinoma.
482
What is the most common type of pancreatic cancer?
Adenocarcinoma accounts for 90% of pancreatic cancer diagnoses.
483
What are the symptoms of pancreatic cancer?
Early stages are often painless; later stages may present with jaundice and a palpable mass.
484
What is the Whipple procedure?
Surgery that involves removal of the head of the pancreas and parts of the small intestine.
485
What is a pancreatic pseudocyst?
Encapsulated collections of fluid surrounded by a fibrous, granulomatous tissue wall with high enzyme concentrations that arise from the pancreas.
486
What are the symptoms of a pancreatic pseudocyst?
May be symptomatic (pain) or discovered incidentally on CT. Usually a result of acute pancreatitis, alcohol abuse, trauma. May resolve spontaneously if < 6 cm and asymptomatic.
487
Why is it called a pseudocyst?
It is called a pseudocyst because it does not have an epithelial lining.
488
What is the treatment for a pancreatic pseudocyst?
Some require drainage if persistent, infected, or over 6 cm. Drainage can be performed surgically or percutaneously.
489
What is Vitamin A deficiency?
This is the leading cause of childhood blindness worldwide. It is fat soluble and important for vision, immune system, kidney function, skin, and mucous membrane function.
490
Where is Vitamin A found?
Found in liver and fish oil, fortified milk, and eggs. Precursor to vitamin A is beta carotene (fruits and veggies).
491
Who is at risk for Vitamin A deficiency?
Elderly, alcoholics, and those with liver disease are at risk.
492
What causes Vitamin A deficiency?
Can occur due to poor diet or malabsorption issues like celiac disease.
493
What are the symptoms of Vitamin A deficiency?
Night blindness, dry eyes which can lead to corneal ulcers, dry skin, poor wound healing, and weakened immune system.
494
How is Vitamin A deficiency diagnosed?
Serum level.
495
What is the treatment for Vitamin A deficiency?
Supplements.
496
What is Vitamin D deficiency?
Vitamin D deficiency is needed to help bones absorb calcium. It is found in fortified milk or produced with exposure to sunlight.
497
Who is at risk for Vitamin D deficiency?
Elderly, infants, and those with low sun exposure are at risk.
498
What is the recommended sunlight exposure for Vitamin D?
The recommended sunlight exposure is 15 minutes to the face, arms, neck, and back twice a week without sunscreen.
499
What health issues can arise from Vitamin D deficiency?
Deficiency leads to Rickets in children and Osteomalacia in adults, along with other health issues like cardiovascular disease and autoimmune disorders.
500
How is Vitamin D deficiency diagnosed?
Diagnosed with serum vitamin D level and hypocalcemia.
501
How is Vitamin D deficiency treated?
Treatment includes sunlight exposure, supplements, or addressing underlying conditions.
502
What is Thiamine deficiency?
Thiamine deficiency, or Vitamin B1 deficiency, enables the body to use carbohydrates as energy, especially important for nerve, muscle, and heart function.
503
Who is at risk for Thiamine deficiency?
Alcoholics are at risk because alcohol impairs thiamine absorption and storage.
504
What conditions can result from Thiamine deficiency?
Deficiency leads to beriberi, which can be wet (heart failure) or dry (neuropathy, Wernicke encephalopathy, Korsakoff syndrome).
505
What are the symptoms of Wernicke encephalopathy?
Symptoms include nystagmus, ataxia, confusion, and memory issues.
506
How is Thiamine deficiency treated?
Treatment involves parenteral thiamine and addressing underlying nutritional causes.
507
What is Vitamin C deficiency?
Vitamin C deficiency is more commonly known as scurvy and is needed for the development and repair of all body tissues.
508
Who is at risk for Vitamin C deficiency?
Alcoholism, lower socioeconomic status, and the elderly are at risk.
509
What are the symptoms of scurvy?
Symptoms include fatigue, muscle weakness, irritability, anemia, swollen bleeding gums, and slow healing wounds.
510
How is Vitamin C deficiency diagnosed?
Diagnosed with decreased plasma levels.
511
How is Vitamin C deficiency treated?
Treatment involves supplements, with improvements seen in days.
512
What is lactose intolerance?
Lactose intolerance is the impaired ability to digest lactose, a sugar found in milk and dairy products.
513
What causes lactose intolerance?
It is genetic and related to the amount of lactose ingested and the amount of lactase present.
514
What are the symptoms of lactose intolerance?
Symptoms include bloating, abdominal cramps, and flatulence.
515
How is lactose intolerance diagnosed?
Self-diagnosed but can be tested with a hydrogen breath test.
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How is lactose intolerance treated?
Treatment includes synthetic lactase or elimination of milk products, ensuring calcium intake from other sources.
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What is Phenylketonuria?
Phenylketonuria is an autosomal recessive disorder identified in newborn screenings, characterized by a nonfunctional hepatic enzyme phenylalanine hydroxylase.
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What happens in Phenylketonuria?
Loss of PAH activity leads to phenylalanine accumulation, causing brain toxicity and intellectual disability.
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How is Phenylketonuria treated?
Treatment involves a lifelong diet low in phenylalanine, avoiding high protein foods and ensuring proper nutrition.
