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GI Flashcards

1
Q

Dysphagia

  • means
  • anatomic presentation differences
A
  • swallowing difficulty
  • oropharynx=liquid dysphagia
  • esophagus=solid dysphagia
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2
Q

Infectious esophagitis

-ddx w/ diagnostics & treatment

A

1) Candida
- yellow-white plaques on palate/tongue
- nystatin or fluconazole
2) HSV
- small, deep ulcerations
- multinucleated giant cells w/ intranuclear inclusions
- +tzank smear
- acyclovir
3) CMV
- large, superficial ulcerations
- intranuclear and intracytoplasmic inclusions
- gancyclovir

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3
Q

Diffuse Esophageal Spasm path, presentation, dx, tx

A

High amplitude non-peristaltic contraction of esophagus with normal* LES relaxation

chest pain, dysphagia ==>precipitated by cold/hot liquids*

Barium swallow: corkscrewing
Manometry: high-amplitude contractions w/ normal LES

nitrates & calcium channel blockers; surgery if severe

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4
Q

Achalasia path*, dx, tx

A

impaired relaxation of LE sphincter & impaired peristalsis of lower 2/3 esophageal smooth muscle
2/2 degeneration of inhibitory neurons of auerbach’s plexus

Barium: bird’s beak @ LES
Manometry: *required for dx… impaired relaxation of LES & impaired peristalsis
Endoscopy: recommended to r/o cancer

Surgery, if healthy
Nitrates & calcium channel blockers, if not

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5
Q

Esophageal diverticula presentation, dx

A

Regurgitating undigested food
Halitosis

Barium swallow outpouchings

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6
Q

Esophageal SCC anatomy, risk factors, dx*

A

upper 2/3 of esophagus 2/2 tobacco & ETOH

barium swallow showing irregular borders ==> CT & ultrasound for staging

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7
Q

Esophageal Adenocarcinoma path, anatomy, risk factors, dx

A

Carcinoma @ lower 1/3 esophagus 2/2 GERD or Barrett’s

barium swallow showing irregular borders ==> CT & ultrasound for staging

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8
Q

GERD pathophysiology, sequelae, presentation*, dx, tx

A

LES relaxation 2/2 incompetence or hiatal hernia ==> barrett’s (columnar intestinal metaplasia) and/or benign peptic strictures

Burn 30-90 after meal
Worse with reclining*
Cough
Water brash
Globus (lump in throat)
Exacerbated by:  ETOH, caffeine, chocolate, garlic, onions, mints, nicotine

Clinical…but if not resolving:

  • barium swallow to look for hiatal hernia
  • EGD w/ biopsy to rule out barrett’s

1- lifestyle
2-PPIs (-prazole) or H2 antagonists (-idine)
3- nissen fundoplication (wrap fundus around esophagus)

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9
Q

Barrett’s pathophysiology, dx*

A

Squamocolumnar metaplasia @ LES border 2/2 GERD

EGD: irregularity of border

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10
Q

Hiatal hernia path w/ commonality, dx

A

1- sliding: GE junction & nearby stomach slides above diaphragm* into esophagus
2- paraesophageal: GE junction stays below diaphragm while other part herniates into thorax
==>95% sliding

CXR (incidental) or barium swallow/EGD

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11
Q

Ascites tx*

A

Na/water restriction ==> spironolactone ==> furosemide ==> paracentesis
*Stop diuresis @ 1L to avoid hepatorenal

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12
Q

SBP presentation, dx, tx

A

Abdominal pain, fever, chills, MS change

Ascites PMN > 250/mL & +Gram Stain

3rd gen cephalosporin
IV albumin
Floroquinolone prophylaxis

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13
Q

Hepatorenal syndrome path, dx, tx

A

Prerenal failure in setting of cirrhosis

Diagnosis of exclusion: urine Na <10, pre-renal Cr elevation, failure to respond to NS bolus

Dialysis & liver transplant

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14
Q

Non-alcoholic fatty liver disease path, presentation, dx, tx

A

Hepatitis progressing to cirrhosis 2/2 metabolic syndrome & insulin resistance

RUQ pain w/ metabolic syndrome (being fat) and/or diabetes

elevated AST/ALT in absence of other lab abnormalities + being fat

Weight loss & fat-restricted diet

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15
Q

Hepatic encephalopathy path, presentation, dx, tx

A

Inability to convert ammonia to urea in liver
2/2 cirrhosis, GI bleed

Insomnia
MS change
Asterixis

Lactulose / lactitol ==> lower serum ammonia
Rifaxamin ==> antibiotic kills ammonia-producing bacteria
Laxative
Protein restriction

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16
Q

Esophageal varices anatomy, tx*

A

?

Non-bleeding: beta blockers
Bleeding: band ligation/sclerotherapy if acute bleeding

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17
Q

Hepatic coagulopathy path**, tx

A

?
Impaired synthesis of clotting factors except VIII

Fresh frozen plasma
(Vitamin K will not work)

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18
Q

Primary biliary cirrhosis path, presentation, dx, tx

A

Autoimmune destruction of intrahepatic bile ducts

Autoimmune hx (usually women)
Jaundice, pruritis, fat-soluble vitamin deficiencies
Xanthomas 2/2 impaired fat storage*

+antimitochondrial antibody
Elevated Alk-P & bilirubin

Ursodial (aka ursodeoxycholic acid) to slow disease
[Cholestyramine for pruritis]
Liver transplant

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19
Q

Hepatocellular carcinoma risk factors, presentation, dx, tx

A

Alcoholic & HCV cirrhosis
Aflotoxins
HBV cirrhosis

RUQ pain, jaundice, bruisability, bleeding
Enlarged liver

Elevated alpha-fetoprotein, LFT abnormalities
Ultrasound or CT

Resection for non-cirrhotic lesions 5cm and/or cirrhotic lesions

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20
Q

Hemochromatosis path, presentation, dx, tx

A

Excessive hemosiderin lodges in heart, liver, pancreatic islet cells, adrenals, testes, kidneys, pituitary

1- autosomal recessive excessive absorption
2- 2/2 transfusions from blood disorders

Bronze skin
Diabetes, hypogonadism, heart failure, cirrhosis, MCP joint pain

Increase serum Fe, ferritin, & transferrin saturation >45% (serum Fe/TIBC)
Decreased transferrin
Biopsy/MRI/HFE gene test

Weekly phlebotomy + deferoxamine

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21
Q

Wilson’s disease path, presentation, dx, tx

A

Autosomal recessive copper transport disorder depositing in liver, basal ganglia, eyes

Hepatitis & cirrhosis
Ataxia, tremor, psychiatric changes <30y/o
Kayser-Fleischer rings, ataxia, choreiform movements, jaundice

Liver biopsy: Mallory bodies, steatosis
Decreased ceruloplasmin
Increased urinary copper
Slit lamp exam

Penicillamine = plasma copper chelator
Zinc = dietary copper chelator
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22
Q

Acute pancreatitis path, risk factors, presentation, dx, complication, tx

A

Leakage of pancreatic enzymes causing auto-destruction

ETOH > gallstones > post-ERCP > hypercalcemia, hypertriglyceridemia, drugs > scorpion bites

Abrupt onset epigastric pain radiating to back, n/v, fever
Grey Turner’s flank discoloration & Cullen’s periumbilical discoloration

Dx: 2+
Amylase / lipase 3x elevation
Characteristic history/PE
Characteristic imaging
==> Abdominal ultrasound: better for showing stones if suspecting cholelithiasis etiology (i.e. non-alcoholic patient)
==> CT: showing enlarged pancreas w/ fluid & fat stranding
ALWAYS DO BOTH*

Pancreatic pseudocyst, shock, fistula, hypocalcemia, pleural effusion

*IV fluids + Analgesia + Bowel rest

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23
Q

Chronic pancreatitis path & risk factors, presentation, dx,

A

Parenchymal destruction leading to insufficiency

ETOH&raquo_space;> gallstones, CF, autoimmune, smoking

Chronic epigastric pain
Onset of DM
Steatorrhea
Anorexia, weight loss

Normal-high amylase/lipase
Xray (or CT): calcifications, chain of lakes pancreatic duct, ileus

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24
Q

Pancreatic cancer path, anatomy, risks, presentation*, dx, tx

A

Adenocarcinoma, 75% in head of pancreas

Smoking, chronic pancreatitis, obesity

Late-onset: jaundice, weight loss, anorexia

  • Courvoisier’s sign: nontender palpable GB
  • Trousseau’s sign: migratory thrombophlebitis

Biliary obstruction: elevated bilirubin, alk-p ==> CT scan if suspecting pancreatic cancer!

Usually palliative
If small in pancreatic head without vessel involvement ==> whipple

Chemo & 5-FU ==> improves survival

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25
Acute gastritis causes
ETOH, NSAIDs, H. Pylori, stress
26
Chronic gastritis types w/ path, sequelae
Type A: autoantibodies to fundus parietal cells ⇒ no IF ⇒ no B12 absorption ⇒ anemia Type B: NSAIDs & H. Pylori damage antrum gastric adenocarcinoma ==> ovarian met (Krukenberg carcinoid tumor)
27
H. pylori dx, tx
Urease breath test Stool antigen IgG (only tests previous infection, not if currently active like above 2) Triple therapy: omeprazole, clarithromycin, amoxicillin/metronidazole
28
H. pylori cancer type*, location, treatment*
MALT: mucosa-associated lymphoid tissue Stomach Triple therapy
29
“Stress” ulcer causes
Burns TBI Other severe illnesses
30
Gastric adenocarcinoma pathophysiology w/ risk factors, presentation*, dx*, tx
- Intestinal: differentiated gastric mucosal cells 2/2 nitrates (think Asians), H. pylori, chronic gastritis - Undifferentiated: no known risk factors Late-stage presentation of indigestion, weight loss, GI bleeding Left supraclavicular Virchow’s node Endoscopy Undifferentiated: Signet ring cells ==> surgery but rarely resectable because of late presentation
31
Peptic Ulcer Disease (PUD) pathophysiology w/ risk factors, presentation, dx
Gastric OR duodenal mucosal irritation 2/2 H. pylori, ETOH, tobacco, NSAIDs, corticosteroids (not stress), ZE Dull, burning epigastric pain (worse with food if gastric, better with food if duodenal). Coffee ground emesis. Dark stool. Sometimes epigastric tenderness & guiac + H. pylori testing MUST RULE OUT: perforation & cancer Upright XR for air under diaphragm Biopsy ulcer
32
Zollinger-Ellison Syndrome pathophysiology w/ association, dx, tx
Elevated gastric acid 2/2 gastrin producing tumor in duodenum or pancreas ==> inactivates pancreatic enzymes ==> malabsorption Associated with MEN-1 (20% of gastrinomas) Ulcers extending into jejunum Increased serum gastrin ==> if non-diagnostic, secretin injection (gastrinoma secretes gastrin with secretin but gastric G cells are inhibited) CT to localize tumor then PPIs + resection of tumor
33
SBO path, presentation*, dx, tx
Adhesions 2/2 surgery, hernias, neoplasms Crampy abdominal pain. Vomiting (bilious if proximal; feculent if distal). No to minimal flatus. Partial = flatus without stool Complete = no flatus or stool Distention, diffuse pain & high-pitched “tinkles” CXR/CT air-fluid levels, dilated small bowel w/ transition point NG tube, fluid resuscitation ==> laparatomy if peritoneal OR septic-looking (hypotensive, fever, significant leukocytosis, acidosis)
34
Ileus pathophysiology w/ risk factors*, presentation*, dx*, tx*
Loss of peristalsis 2/2 electrolyte derangement, abdominal surgery, other illnesses n/v, no flatus or BM distention *absent bowel sounds (unlike tinkling of SBO*) Air throughout large & small bowel without transition point NPO. NG suction. Parenteral feeds. Remove narcotics that slow motility
35
Gallstone ileus pathophysiology, dx
Gallstone erodes through wall into small bowel & lodges in ileocecal valve Upright XR showing SBO + gas in biliary tree
36
Acute mesenteric ischemia etiologies*, presentation*, dx, tx
Thrombotic, usually 2/2 SMA atherosclerosis Embolic, usually 2/2 A-fib Nonocclusive 2/2 low cardiac output Venous thrombosis n/v, diarrhea, bloody stools pain out of proportion to exam Elevated WBC, LDH, etc. Angiography = diagnostic Anticoagulate or laparotomy
37
Diverticulosis path w/ risk factors, presentation*, dx, tx
Mucosal outpouchings, usually sigmoid colon 2/2 low fiber diet & age Acute painless GI bleeding Constipation Abdominal pain Colonoscopy after resolution…risk of perforation if too soon High fiber diet
38
Diverticulitis path, presentation*, dx, tx**
Infected diverticum 2/2 fecalith n/v, fever, abdominal pain [note no diarrhea necessary] LLQ abdominal pain ``` Uncomplicated: Leukocytosis CT ==> inflammation & wall thickening -------- Complicated: CT ==> fluid (aka abscess) perforation, fistula ``` Uncomplicated: NPO, broad spectrum abx (oral or IV), only hospitalize elderly or immunocompromise ---------- Complicated: Abscess 3cm: CT drainage ==> surgical drainage if not resolving by day 5 Resection: fistula, perforation, repeated episodes
39
Large bowel obstruction etiology, presentation, dx, tx
Assume cancer Less intense n/v & distention than SBO XR w/ enema or CT showing dilated sigmoid colon Rectal tube or surgery
40
Colorectal cancer risks | Polyp types* (high-yield)
Age >70 UC > Chrons Strep bovis* Adenomas: Sessile >> stalked Villous >> tubular >2.5cm = bad! Non-adenomas: Hyperplastic & hamartomatous = non-neoplastic
41
Colorectal cancer screening recommendations
No hx: @50, guiac Q1year + colonoscopy Q10 or sigmoid Q5 Ca hx: @40 or 10 years younger than relative, colonoscopy Q10 UC: Colonoscopy Q2 8-ish years after diagnosis
42
Colorectal cancer presentation
R-sided: fatigue 2/2 anemia, anorexia, rarely obstruction | L-sided: change in bowel habits, obstruction, bloody stools
43
Ischemic colitis path*, presentation*, dx, tx
Watershed areas: splenic flexure & rectosigmoid junction ``` Atherosclerosis hx Hypotensive event Abdominal pain Bloody diarrhea Fever, n/v ``` Extreme leukocytosis Colonoscopy showing pale mucosa & bleeding Fluid & broad spectrum abx Surgery if peritonitis
44
Upper GI vs lower GI bleed anatomical distinction
Ligament of Treitz @ duodenum/jejunum
45
Upper GI bleed ddx, presentation, workup, tx*
PUD > esophageal varices, Mallory Weiss tear, Boerhaven(?), esophagitis, gastritis Hematemesis (coffee ground) or melena (dark stool) > hematochezia NG tube w/ lavage ⇒ endoscopy if stable Fluid / pRBCs Intubate if airway at risk* Endoscopy
46
Lower GI bleed ddx, presentation, workup*
Diverticulosis > angiodysplasia, IBD, hemorrhoids, AVM Hematochezia NG lavage to r/o UGI bleed ⇒ ano/colonoscopy if stable [*anoscopy first if RBC scintigraphy if colonoscopy fails
47
When to give pRBCs & how much*
@7Hgb (?) 1 unit increases Hgb g/dL & hematocrit 3-4units
48
Crohn’s path, anatomy, presentation, associations, dx*, tx*
Transmural inflammation (neutrophilic cryptitis) with discontinuous skip lesions, fistulas, fat, non-caseating granuloma*, bowel wall thickening Anywhere in GI tract especially ileocecal region, EXCEPT rectum Bimodal age distribution: 20's and 60's Watery diarrhea, abdominal discomfort Perianal fissures/fistulas Erythema nodosum Migratory polyarthritis Kidney stones leukocytosis & anemia during flares XR: string sign bowel thickening Colo: strictures on XR, cobblestoning/skip lesions Biopsy: transmural, cobblestone, fat, granuloma 5-asa (sulfasalazine, mesalamine) ⇒ azathiophrine/infliximab
49
Ulcerative colitis path w/ anatomy, presentation w/ associated findings*, dx, tx
Mucosal & submucosal inflammation (neutrophilic cryptitis) in continuous fashion, crypt abscess, pseudopolyps Only colon (hence name), ALWAYS rectum Bimodal age distribution: 20's and 60's Bloody diarrhea, abdominal discomfort Pyoderma gangenosum, increased colorectal cancer risk, apthous stomatitis, uveitis, arthritis, primary sclerosing cholangitis, erythema nodosum Leukocytosis & anemia during flares Colo: lead pipe loss of haustra on XR, continuous ulcers & polyps 5-asa (sulfasalazine, mesalamine) ⇒ azathiophrine/infliximab ==> proctocolectomy
50
Crohn’s vs UC diagnosis*
Crohn’s: strictures on XR, cobblestoning/skip lesions on colonoscopy, non-caseating granuloma, rectal sparing UC: lead pipe loss of haustra on XR, continuous lesions & pseudopolyps on colonoscopy, rectal involvement Both: leukocytosis & anemia during flares
51
Crohn’s vs UC tx
Both: 5-asa (sulfasalazine, mesalamine) ⇒ azathiophrine/infliximab UC: proctocolectomy
52
Crohn’s vs. UC risks**
Crohn’s: increased cancer | UC: markedly increased cancer risk requiring Q1-2 colonoscopies 8 years post-dx
53
**** | Direct vs. indirect inguinal hernia, anatomy
?
54
Acute cholecystitis path* w/ associations, presentation, dx, tx
GB stone + inflammation Chronically ill / TPN: acalculous Ileal resection: Decrease bile acid recirculation ⇒ changes bile composition ⇒ cholesterol supersaturation causing gallstone formation RUQ pain n/v, fever stone/sludge+inflammation+murphy’s on ultrasound, leukocytosis Tx: cholecystectomy +/- abx if cholecystitis
55
Acalculous cholecystitis path*, dx*
Chronically ill / TPN patients lack CCK release 2/2 no food, thus stasis Pericholecystic fluid without stones
56
If cholecytitis ultrasound is equivocal
HIDA scan showing no tracer entering GB
57
Choledocholithiasis path, presentation, dx
Stone in CBD Jaundice, biliary colic, fever, +/-pancreatitis Elevated T&D bilirubin, elevated Alk-P ERCP = diagnostic & therapeutic (ultrasound is low sensitivity
58
Cholelithiasis/colic path, presentation, dx, tx*
Stone in GB ==> no inflammation post-prandial RUQ pain n/v stone on ultrasound Surgery only if symptomatic
59
Ascending cholangitis path, presentation, dx, tx
Infection of biliary tree (gram negative enterics E. coli, Klebsiella) 2/2 choledocholithiasis, sclerosing cholangitis, biliary stricture, malignancy Charcot’s triad: jaundice, RUQ pain, fever/chills Reynold’s pentad: jaundice, RUQ pain, fever/chills, sepsis, AMS Leukocytosis, elevated T&D bilirubin, elevated Alk-P ERCP + broad spectrum abx
60
Primary sclerosing cholangitis path w/ association, presentation, dx, tx
Idiopathic inflammation/fibrosis of larger intra&extra hepatic bile ducts Jaundice, pruritis, fatigue IBD, esp. UC** Elevated Alk-P bilirubins Maybe +p-anca ERCP showing beading of biliary tree Liver biopsy showing ductal sclerosis (“onion skinning”) Ursodiol/ursodeoxycholic (reduce bilirubins?) ERCP + stenting Liver transplant
61
Bilirubin metabolism mechanism
RBC breakdown in spleen ⇒ hemoglobin ⇒ unconjugated/indirect bilirubin-albumin complex ⇒ conjugated/direct in liver ⇒ excreted via GI or as dark urine if backed up Conjugated elevation = hepatic backup Unconjugate elevation = hemolysis etc.
62
Hyperbilirubinemia ddx*
Conjugated/direct: defective excretion, Dubin-Johnson, Rotor’s Indirect: hemolytic anemia, Gilbert’s (high-normal), Crigler-Najjar
63
Hepatitis A path, presentation*, dx*, tx
RNA virus transmitted fecal-oral Usually 2/2 overcrowded conditions (3rd world) Acute abdominal pain, malaise Dark urine Aversion to smoking Transient ALT/ASK, Alk-P, bilirubin elevations Supportive care
64
HBV path, presentation courses*, dx w/ serum marker time courses*, clearance dx*, tx*
DNA virus transmitted sexually, parenterally, vertically 90%: acute with full recovery 5%: chronic HBV 5%: fulminant hepatic failure ==> increasing PT/PTT*, decreasing AST/ALT* 2/2 fewer hepatocytes, encephalopathy*, etc HBsAg: HBV antigen indicating viral carrier; earliest marker of infection *Anti-HBsAg: HBV antibody indicating vaccine immunity or viral clearance *Anti-HBc: first antibody to HBsAg, prior to "window phase" of anti-HBsAg. IgM version indicates acute infection. IgG version indicates chronic infection or recovery (if anti-HBs present) *HBeAg: early phase antigen indicating viral replication and transmissibility risk... if it persists, risk for chronic infection increases Anti-HBe: antibody arising in “window” period that indicates low transmissibility risk Inactive carrier: Positive HBsAg, Positive Anti-HBe, Negative HBeAg, Positive 3+ ALT or 2+ DNA normal levels All: Interferon + lamivudine / adefovir Fulminant: STAT liver transplant...IF not abusing drugs
65
Autoimmune hepatitis dx*
Anti-smooth muscle Ab
66
HCV path, presentation*, dx*, tx*
RNA virus transmitted parenterally, mostly Mild hepatitis prodrome ==> progresses to cirrhosis and HCC HCV RNA level ==> if present, liver biopsy* to assess stage Ultrasound q6 months for cirrhotics to r/o HCC Interferon & ribavirin (after liver biopsy*)
67
Sequelae of chronic hepatitis
HCC, cirrhosis, liver failure
68
Cirrhosis pathophysiology, causes*, presentation*
Fibrosis & nodularity of liver Hepatitis, biliary tract disease, Budd-Chiari (hypercoagulability thromboses hepatic vein), R-sided heart failure, hemochromatosis, Wilson’s disease, alpha-1-antritrypsin deficiency*, drugs/alcohol Amenorrhea (women) Men: hyperestrogen 2/2 inability to metabolize ==> hypogonadism, decreased libido, telangiectasias, gynecomastia, palmar erythema Low T3/T4 (2/2 decreased serum binding proteins)*
69
SAAG meaning*
SAAG: serum albumin MINUS ascites albumin >1.1=portal hypertension (increased capillary hydrostatic pressure*) <1.1.=non-portal HTN (nephrotic, TB, malignancy)
70
Tropical sprue hx/pe
Travel Malabsorptive diarrhea Hyperactive bowels
71
Whipple's disease presentation, dx*, tx
Older white male Weight loss, diarrhea/malabsorption Extra intestinal manifestations: migratory polyarthritis, cough, hyperpigmentation, fever, lymphadenopathy, valvular disease/heart failure, CNS dysfunction Small intestine biopsy: PAS-positive macrophages in lamina propria with gram+ bacilli Abx
72
C. diff presentation, sequalae, dx, tx*
Abx hx Watery BM ==> toxic megacolon Leukocytosis, fever Toxic megacolon C. diff stool PCR Oral metronidazole: WBC15,000 or Cr >1.5 Vanc + metronidazole: ileus + above Colectomy: WBC>20,000 peritoneal
73
Endoscopy vs PPI as initial management in dyspepsia
Endoscopy: If >55 or warning signs of weight loss, dysphagia, vomiting, bleeding, family history) PPI/Hpylori test: If none of above
74
Giardia dx, tx
Stool sample ⇒ ova and parasites Metronidazole
75
VIPoma path, presentation, dx, tx
Vasoactive intestinal peptide tumor in pancreas Diffuse watery diarrhea (hallmark), cramps 2/2 hypokalemia, abdominal pain, flushing High VIP in blood stream ⇒ CT to locate Surgical resection if not metastasized
76
Toxic megacolon presentation, dx, tx
Bloody diarrhea Often IBD hx Fever, tachycardia, neutrophilic leukocytosis, anemia, volume depletion X-ray: distension >6cm ``` IV steroids (if IBD) or abx (if bacterial) + NG tube ==> surgery if unresolving ```
77
Celiac path, presentation*, dx*
Gluten (gliadin) allergy causing villous blunting 2/2 IgA deposition Weight loss, foul bulky stools, joint pain Fe deficiency anemia 2/2 malabsorption Dermatitis herpetiformis: extensor elbow/knee rash Often associated with type 1DM Biopsy: villous atrophy D-xylose test: should absorb in proximal small intestine unless malabsorption occurring IgA anti-tissue transglutaminase and/or IgA anti-endomysial antibodies…unless! Selective IgA deficiency which is common in celiac
78
Pharyngeoesophageal (Zenker’s) diverticulum path, presentation*
Herniation posteriorly above UES through cricopharyngeal muscle 2/2 sphincter & esophageal dysmotility Liquid/solid dysphagia @ oropharynx with mass
79
Dubin-Johnson path, presentation, dx*, tx
Icterus Fatigue +/- trigger Elevated direct bilirubin (Gilbert's is indirect) Otherwise normal Elevated coporphyrin 1 No treatment
80
Drug-induced esophagitis causes
Tetracyclines Aspirins/NSAIDs Alendronate KCl, quinidine, Fe
81
Zinc deficiency path & PE
Jejunum absorption | Alopecia, skin lesions, poor wound healing
82
Vitamin A deficiency hx/pe
Blindness, dry skin, poor immunity
83
GI bleeding effect on kidney
Elevated BUN:Cr ratio 2/2 blood reabsorption increasing urea levels
84
Benign peptic stricture path*, presentation*, dx
GERD causing symmetric stricture @ distal esophagus GERD hx that resolves (2/2 narrowing) Solid dysphagia Barium swallowing showing symmetric ring
85
Angiodysplasia presentation
Painless rectal bleeding Aortic stenosis Renal failure
86
Anal fissure presentation, dx, tx*
Painful shits 2/2 constipation Tear on anus Local anesthetic, stool softener, high-fiber diet
87
Most common cause of iron deficiency anemia in elderly:
GI bleed ==> colonoscopy then endoscopy
88
Carcinoid syndrome path, presentation*, dx*, tx*
Tumor of ileum or appendix ==> secrete serotonin ==> once metastasized to liver, symptoms begin ``` TRIAD: Flushing/wheezing Diarrhea Cardiac valve lesions ----- 3D'S of niacin deficiency 2/2 increased serotonin diarrhea, dermatitis, dementia, death ``` High urine 5-HIAA (serotonin metabolite) CT & octreotide scans localize tumor Octreotide & surgical resection
89
Mallory-weiss tear path*, presentation*, tx*
Ruptured artery @ GE junction with incomplete mucosal tear Recent vomiting Hematemesis Usually resolves Vasopressin or endoscopy may be required
90
Boerhaave tear path, presentation*, dx*, tx*
Full-thickness esophageal rupture, usually above GE junction Pain post-vomiting Septic-looking Crepitus @ suprasternal notch* Hamman's sign: crunch sound on cardiac auscultation 2/2 air CXR showing pleural effusion, pneumomediastinum, pneumothorax ==> water soluble contrast esophagram* Surgery
91
Tropical sprue dx
``` Macrocytic anemia (2/2 B12 folate deficiency) Blunted villi w/ chronic inflammatory cells ```
92
Factitious diarrhea dx
Profuse watery stools | Brown colon w/ shiny lymph patches (melanosis coli)
93
Niacin deficiency name, hx, pe
Pellagra Corn-based diets Alcoholics Carcinoid syndrome 2/2 serotonin overproduction 4D's: dermatitis, diarrhea, dementia, death
94
Small intestinal bacterial overgrowth presentation*, dx
Surgeries, motility disorders (scleroderma, diabetes) etc. ==> bloating, diarrhea Dx: Jejunal aspirate
95
Lactose intolerance dx
+hydrogen breath test +stool reducing substances Low stool pH Increase stool osmotic gap
96
Drug induced pancreatitis drugs*: (memorize for USMLE)
``` Diuretics: furosemide, thiazides IBD drugs: sulfasalazine, 5asa Immunosuppresed patients: azathioprine Bipolar/seizure: valproic acid AIDs: ARVs Abx: metronidazole, tetracycline ```
97
Esophageal dysmotility path (???)
Absent peristaltic waves and decreased LES tone | 2/2 scleroderma
98
Dumping syndrome path, presentation*, tx*
Post gastrectomy excess tonicity enters duodenum => pulls fluid and releases vasoactive peptides Weakness, cramps, sweating Dietary change Octreotide if refractory
99
Pyloric stricture path, hx/pe*, tx
Gastric outlet stricture 2/2 malignancy, PUD, ingestion, bezor ``` Vomiting partially digested food Succussion splash (stethoscope on belly ==> splash) ``` Surgery
100
Bowel ischemia vs acute mesenteric ischemia*
Bowel: - less severe pain - CT shows thickened bowel - colonoscopy shows focal area of ulceration with normal sites above and below
101
Crohn's and urinary stones path*
Crohns fat malabsorption causes excess calcium:fat binding resulting in increased free oxalate for absorption ==> oxalate stone predisposition True for any malabsorptive disorder
102
Nasopharyngeal carcinoma path, presentation*, dx, tx
Squamous cell undifferentiated cancer 2/2 EBV, nitrosamines Mediterranean and eastern men Epistaxis Otitis media Nasal obstruction Elevated EBV level Biopsy Usually metastatic once found
103
Gilbert syndrome path, presentation*, dx*, tx
Enzyme deficiency preventing bilirubin conjugation ==> asymptomatic / benign Icterus Malaise Often 2/2 stressful event Mildly elevated unconjugated (indirect) bilirubin No tx
104
Crigler Najar syndromes 1 & 2 path, presentation*, dx*, tx
Autosomal recessive inability to conjugate bilirubin Type 1: infantile severe jaundice and kernitcerus (bilirubin encephalpathy) Type 2: milder jaundice without kernicterus Type 1: normal liver histology; severe indirect bilirubin elevation WITHOUT decrease with phenobarbitol administration Type 2: normal liver histology; milder indirect bilirubin elevation WITH decrease with phenobarb administration Type 1: phototherapy and plasmapheresis ==> liver transplant Type 2: none
105
Rotor syndrome path, presentation, dx, tx
Defect of hepatic storage of conjugated / direct bilirubin Jaundice Benign elevation of conjugated AND unconjugated bilirubin None
106
Porcelain gallbladder path, presentation, risk*, dx, tx*
Calcium deposition 2/2 chronic cholecystitis Biliary colic Progresses to gallbladder carcinoma* Calcified rim Cholecystectomy
107
Biliary tree anatomy*
``` Liver: common hepatic GB: cystic ==> converge @ CBD Pancreatic duct joins CBD ==> all juices exit @ sphincter of Oddi ```

STEP2 (16 decks)

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