GI Flashcards
(139 cards)
0
Q
What are the drugs common in pill induced esophagitis?
A
Quinine, vitamin c, doxy, NSAIDs, iron. Treat with sucralfate.
1
Q
Name three causes of infectious esophagitis and their treatment.
A
Candida nystatin, herpes acyclovir, CMV gwnciclovir.
2
Q
Chest radiation over what causes radiation esophagitis?
A
3000 rad
3
Q
What causes achalasia?
A
Loss of ganglion cells in auerbach’s plexus leads to increased tone and impaired relaxation of the LES, absent peristalsis.
4
Q
How doe people with achalasia present?
A
Dysphagia to liquids and solids, regurgitation hours after eating
5
Q
What are the labs associated with achalasia and the treatment?
A
X-ray: dilated bird beak stricture, Manometry: incomplete relaxation of LES
Treatment: nifedipine, muscle relaxant; pneumatic dilation, botulinum injection
6
Q
Describe a Mallory-Weiss tear. Who is prone, how do they present and what is the treatment?
A
No penetrating mucosal tear at the GE junction due to rise in trsnssbdominal pressure, alcoholism strong predisposing factor. Patient presents with painless hematemesis and dx with endoscopy. Treat with epi or cauterization.
7
Q
What are esophageal neoplasms linked to and what are the two most common kinds?
A
Chronic irritation and inflammation. Squamous cell carcinoma and adenocarcinoma (linked to Barrett’s esophagus)
8
Q
What are the risk factors of esophageal carcinoma?
A
Smoking, alcohol, achalasia, RT
9
Q
How does a patient with esophageal carcinoma present?
A
Complains of a mechanical obstruction, progressive dysphagia with solids then liquids, odynophagia, anemia, wt loss, enlarged lymph nodes.
10
Q
What lab do you use to detect esophageal neoplasm?
A
Barium swallow, EGD with biopsy. Barium swallow shows dilated esophagus above stricture. Treat with surgery or RT/chemo 5-FU.
11
Q
Describe an esophageal stricture at the lower esophageal ring.
A
Schatzki ring. Intermittent solid dysphagia. Dx with barium swallow, treat with bougie dilators.
12
Q
Describe the dx and treatment of zenker’s diverticulum.
A
Protrusion of pharyngeal mucosa at proximal esophagus. Present with dysphagia, halitosis, regurgitation. Dx with barium swallow and treat with surgery.
13
Q
What is an esophageal web and the treatment for it?
A
Non-circumferential thin squamous mucosal membrane in mid or upper esophagus. Usually asymptomatic and associated with severe iron deficiency anemia and dysphagia. Treat with esophageal bougie.
14
Q
What is an esophageal varices?
A
Dilated sub mucosal veins secondary to portal hypertension (due to cirrhosis). Patient presents with s/s of acute GI bleed. Treat with endoscopy.
15
Q
What is the etiology of GERD?
A
Loss of resetting LES tone, allows reflux of gastric contents into the esophagus.
16
Q
How does a patient with GERD present?
A
Recurrent heartburn, belching, regurgitation, sore throat. Red flags are progressive dysphagia, recurrent pneumonia, persistent cough, bleeding….. These need endoscopic exam.
17
Q
Lab testing for GERD?
A
24 hr ph monitoring, EGD.
18
Q
Treatment t for GERD?
A
Elevate head of bed 6 inches, stop smoking and alcohol intake, reduce fat and meal size, avoid bedtime snacks, avoid trigger foods.
19
Q
Medication treatment of GERD?
A
H2 blockers, PPI, surgery,
20
Q
What is gastritis and three common causes of it.
A
Inflammation, erosion or damage of the gastric mucosa. Stress, h. Pylori, NSAIDs are common causes.
21
Q
What are the two types of gastric neoplasm?
A
Adenocarcinoma -95% M>W, never under 40;
Lymphoma- common place for non-Hodgkin’s lymphoma
Risk factors are h. Pylori infection, dietary, smoking, pernicious anemia, chronic peptic ulcer disease, gastritis.
22
Q
What are the clinic signs of gastric neoplasm.
A
Dyspepsia, weight loss, occult bleeding, progressive dysphagia, post prandial vomiting, early satiety.
23
Q
How to treat a gastric neoplasm!
A
Chemo, surgery, radiation
24
What is Zollinger-Ellison syndrome?
Gastrin producing endocrine tumor (duodenal or pancreatic) leading to hyper secretion. Common in ages 35-65 men garter than women. Patients complain of heartburn, abdominal pain and diarrhea. Elevated gastrin level off PPI and H2 blockers, EGD shows multiple ulcers. Treat with PPI and surgery.
25
What is peptic ulcer disease and what are some contributing factors?
An imbalance between the aggressive and defensive factors in the gastroduodenal mucosa. H. Pylori, NSAIDs, medical conditions.
26
How do patients present with PUD?
Recurrent episodes of deep gnawing or burning midepigastric pain, pain with eating (gastric) or relief with food (duodenal), nausea. May have pos TTP to RUQ. Labs show h. pylori, or EGD with bx.
27
What is the triple therapy treatment for h. Pylori? Quad therapy?
Triple: PPI, amoxicillin and clarithromycin x 7-14 days
Quad: PPI, bisthmuth, amox and clarithromycin x 4-10 days
28
What LSB tests test for hepatocellular damage?
AST/ALT, LDH, urobillnogen
29
What lab tests test for cholestasis?
Alk phos, GGT, bilirubin, urobillnogen
30
What labs test for liver synthesis?
Albumin, PTT, cholesterol.
31
What is AST/ALT?
Released with hepatocellular damage. Also found in muscle. ALT is more liver specific. Increased in hepatitis, toxic injury, ischemic injury, cirrhosis.
32
What is alk phos?
Found in bone, liver, ingesting, kidney and pancreas. Elevations seen in acute biliary obstruction. Also elevated in chronic inflammation of bile duct, neoplasm or Tb, drug toxicity, biliary obstruction.
33
What is GGT?
Gamma- glutamyl transpeptidase. Increases in cholestasis. Alcohol may a.so increase.
34
Bilirubin?
Breakdown product of heme metabolism. Jaundice at levels >2.5. Isolated elevations without increase in LFT may be familial
35
What is prothrombin time?
Factors 2,5,7,9,10 produced in liver. Elevated PT is evidence of severe liver dysfunction.
36
Describe cholecystitis.
Inflammation of the gallbladder from obstruction by a stone on the cystic duct and inflammation and infection by bowel flora.
37
What are the risk factors for cholecystitis?
Fat, forty, fertile, female on Meds with elevated triglycerides.
38
How does a patient with cholecystitis present?
RUQ pain, fever, leukocytosis. Pain is steady, may radiate to scapula, 15-30 min after meal. Associated with nausea, vomiting, dehydration.
39
What is the PE, labs, and tx for cholecystitis?
RUQ TTP, pos Murphy's sign, decreased bowel sounds, guarding. Increased WBC with left shift, increased bilirubin and alk phos. On ultrasound: thick gallbladder wall with sludge or stones, tx: abx amp and gent, surgery.
40
What is cholangitis?
Infection of the bile duct due to stones, strictures, tumors. Symptoms include jaundice, fever, abdominal pain in RUQ, Charcots triad, increased WBC and LFT.
41
What is Charcots triad?
Abdominal pain, fever, jaundice in cholangitis.
42
How do you dx and treat cholangitis?
Ultrasound or ERCP, abx amp and gent
43
What is hepatitis, and how does the patent present ?
Inflammation of the hepatocytes causes by virus, toxins, autoimmune. Patient has fatigue, malaise, nausea, anorexia, icterus, Hepatomegaly, dark urine and light stool.
44
Describe how hepatitis A is transmitted and the treatment.
Fecal to oral, or shellfish. No chronic hepatitis in hep A, incubation 20-40 days, tx= vaccine or post exposure immunoglobin to contacts.
45
Describe hepatitis b, transmission, incubation and treatment.
Transmitted by direct contact with blood or body fluids. Acute and chronic dz. Incubation 60-100 days. Treatment: lamivudine, immunoglobulin, vaccine at 0,1,6 months.
46
Describe hepatitis c, transmission and treatment.
Transmitted by blood and body fluids, 6 wks to seroconversion. 50-80% developed chronic. Treatment is peg interferon Alpha and ribavirin.
47
Describe hepatitis d.
Transmitted paternally, only with hepatitis B. Treatment is hepatitis b vaccine.
48
Describe hepatitis e, transmission, and treatment.
Transmitted by fecal to oral. Incubation 15-60 days. Contaminated food and water. No chronic dz, no treatment.
49
What is cirrhosis. What does it look like on PE?
End stage of chronic liver dz. It involves fibrosis and is irreversible. Patient presents with weakness, anorexia, wt loss, abdominal pain. PE shows jaundice, edema, spider angiomas, telangectasias, palmar erythema, purpura, gynecomastia,
50
What is the dx and treatment for cirrhosis?
Dx: determine underlying dz, abdominal ultrasound, CT scan with liver bx. Tx: avoid alcohol, treat underlying cause, liver transplant.
51
Treatment of varices?
BBlocker to decrease portal pressure
52
Tx of ascites?
Salt restriction and spironolactone , paracentesis
53
Treatment of hepatic encephalopathy?
Lactulose
54
Wilson's dz?
Autosomal recessive, Keyser-fleischer rings, increased copper level, chelation is tx.
55
Hemochromatosis?
Autosomal recessive, abdominal pain, Hepatomegaly, cirrhosis, increased ferritin, phlebotomy.
56
What causes portal hypertension?
Due to anteriovenous shunting or obstruction.
57
Clinical signs of portal hypertension?
Caput medusae, ascites, hyperspleenism, liver failure.
58
Describe primary biliary cirrhosis.
Idiopathic autoimmune disorder in meddle aged women. Presents with fatigue and puritis. Diagnosis by BiOPSY and positive anti mitochondrial antibody. Treat with urs-acid or cholestyramine
59
What is acute pancreatitis and the etiology?
An inflammatory dz of the pancreas resulting in edema, vascular injury, tissue loss and necrosis. Pancreas returns to normal after episode. From gallstones, alcohol, Meds, trauma, hyperlipidemia.
60
What medications commonly cause acute pancreatitis?
Immunosuppressants, bactrim, pentamidine, furosemide, thiazides ACEI, estrogens
61
What are the levels of triglycerides in acute pancreatitis?
>1000 mg/dL
62
What are some clinical signs and exam findings of a patient with acute pancreatitis?
Constant midepigastric /LLQ deep boring pain
Radiation to back
Severe nausea and vomiting.
Grey-turner sign, Cullen's sign, pleural effusion.
63
What is grey-turner sign?
Flank ecchymosis associated with pancreatitis.
64
What is Cullen's sign?
Periumbilical ecchymosis associated with pancreatitis.
65
What do the labs look like in acute pancreatitis?
Amalyse/lipase increases. Amalyse up in 2-12 hrs and down 3-5 days.
Lipase best test and elevated longer!
Increase AST/ALT, leukocytosis, ultrasound to rule out gallbladder dz. CT scan to evaluate for complications.
66
What is the treatment for acute pancreatitis?
Alcohol absence, pain control, NPO, IV fluids.
67
What is Ranson's criteria?
```
For acute pancreatitis.
Age: >55
WBC: > 16,000
AST:>250
LDH: >350
```
68
What is chronic pancreatitis and the most common cause?
Inflammatory disease with progressive and permanent damage to pancreas. Alcohol abuse 90% of cases. Gallstones DO NOT cause.
69
What are the clinical and exam findings of chronic pancreatitis?
Intermittent and chronic abdominal pain, diarrhea and seatorrhea, weight loss, jaundice. The patient is thin, with mild jaundice and diffuse abdominal tenderness.
70
What are the labs, X-ray and treatment for chronic pancreatitis?
Amylase and lipase are normal, bilirubin is increased, 72 hr fecal fat. Pancreatic calcification a on abdominal X-ray. ERCP is best test. Treatment: abstain for alcohol, pain control, enzyme replacement, surgery.
71
What is the most common form of Pancreatic cancer and the 5 year survival rate?
Ductal adenocarcinoma with 5 yr survival at <5 %
72
What are the risk factors of pancreatic cancer?
Smoking, hx of chronic pancreatitis, obesity, high fat diet.
73
What are the early and late clinical findings of pancreatic cancer?
Early: nonspecific abdominal pain, nausea/vomiting, anorexia, malaise
Late: wt loss, obstructive jaundice
Painless jaundice is not very common.
74
Exam, labs, and treatment for pancreatic carcinoma?
Large, no tender, palpable gallbladder (courvoisier's sign), jaundice.
Anemia, elevated alk phos/bilirubin/AST/ALT, ERCP with biopsy, tumor marker CA-19-9 positive. Treat with surgery and palliative care.
75
Describe appendicitis and the clinical presentation.
Inflammation and infection of the appendix by obstruction forms fecalith. Intermittent peri umbilical pain initially and then RLQ pain with McBurney's point tenderness, nausea, fever, decreased appetite. Pos rovings sign and positive psoas sign with peritonitis.
76
How to dx appendicitis?
Ultrasound or ct, tx is surgery.
77
Describe diverticulosis.
Presence of diverticula. 80% asymptomatic, LLQ pain or painless recital bleeding. On exam: firm tenure mass on LLQ exam, normal labs, treat with high fiber diet.
78
What is diverticulitis and how does not present clinically?
Inflammation and infection of diverticulum. Acute LLQ pain, anorexia, fever, chills, n/v, exam shows decreased bowel sounds, distension, rebound tenderness, guarding and fever.
79
H w can diverticulitis show up on X-ray?
Air fluid levels, BE shows lesions or appendages, CT scan can show abscess, perf, colonic wall thickening.
80
Treatment of diverticulitis?
Abx: cipro and flagyl, clear diet and IV fluids, surgery
81
Describe ulcerative colitis and the clinical picture.
15-25, 55-65. 1/3 develop colon cancer.
Involves only mucosa and sub mucosa, starts in rectum and is continuous, fistulas and fissures are rare.
Clinical: pain in LLQ, fever, wt loss, fecal urgency, incontinence.
Bloody mucus stool, may have arthritis.
82
Physical exam for ulcerative colitis?
Pale, tachycardia, fever, distension, decreased bowel sounds, LLQ tenderness. Heme pos stools.
83
What does ulcerative colitis look like on BE?
Loss of ahustral markings, luminal narrowing. On sigmoidoscopy edema, pus, easy friability.
84
Treatment for ulcerative colitis?
5-aminosalicylic acid, steroids, infliximab, colectomy.
| Complications toxic mega colon.
85
Describe Crohn's disease.
15-25, 55-65. Transmural. Fistulas and fissures are common.
| Skip lesion or cobble stoning is hallmark.
86
What is the clinical presentation of a person with Crohn's disease?
Diarrhea, abdominal pain, weight loss, low grade fever, relief of pain with defecation. On exam they are thin and undernourished. Aphthous ulcers. Pos TTP to RLQ. Fistulas and fissures on rectal exam.
87
What does the colonoscopy show in Crohn's disease?
Cobblestoning and skip lesions.
88
Treatment for Crohn's disease?
5 aminosalicylic acid.
| Steroids, infliximab, surgery.
89
What is the Rome criteria?
To diagnose IBS. Must have two or more:
1. Pain relieved with defecation.
2. Pain associated with increased or decreased stool frequency.
3. Pain associated with harder or looser stools.
90
Describe celiac disease.
Inflammatory reaction in the upper small intestine. Present with iron deficiency anemia. Autoimmune disorder! Precipitated by ingestion of gluten.
91
What is the clinical presentation of celiac, how do you make a dx, and the treatment?
Watery diarrhea, abdominal pain, malabsorption and dermatitis herpetiform on extensor surfaces. Dx IgA antibody screening test, small bowel biopsy, treatment is gluten free diet.
92
What is IBS and the signs and symptoms?
Due to abnormal motor function of ether GI tract and gut visceral sensitivity. Cramps, lower abdominal pain relieved by defection, alternating between diarrhea and constipation.
93
Treatment for IBS?
Increase fiber, avoid milk and fatty diet. Miralax, loperamide.
94
What is the typical etiology of colorectal cancer and some risk factors?
Adenocarcinoma. Risk factors are high fat, low fiber diet, smoking, UC, familial polyposis, alcohol.
95
Clinical sx of colorectal cancer?
Asymptomatic for years the change in bowel habits, pain, rectal bleeding, change in stool diameter, weight loss.
96
Treatment for colorectal cancer?
Colectomy, chemo with 5FU, radiation for rectal, monitor response with CEA.
97
Who gets screened for colorectal cancer?
50-75, annual FOBT, 5 yrs flex sig, 10 yr colonoscopy.
98
Describe hereditary nonpolyposis colorectal cancer.
Lynch's syndrome. Most common, onset age 40, no polyps.
99
What is Gardner's syndrome?
Numerous colon polyps with extraintestional manifestations.
100
What is peutz-jeghers syndrome?
Age 20, colon polyps, mucotaneous pigmentation.
101
What is the most common cause of small bowel obstruction?
Adhesions.
102
He does a SBO present?
Vomiting and abdominal pain. Increased bowel sounds.
103
What shows ladder like pattern do dilated loops of bowel with air fluid levels?
SBO
104
How do youngest a SBO?
Decompression with a NG tube or surgery.
105
What causes large bowel obstructions?
Secondary to carcinoma, diverticular dz, inflammatory disorder, or fecal impaction.
106
What presents with a deep visceral cramping pain referred to the hypogastrim, with high pitched bowel sounds and constipation?
lBO
107
What reveals a distended colon in a picture frame outline of the abdominal cavity?
LBO
108
What is the test of choice for a LBO?
Ct scan with rectal contrast. Tx? Surgery.
109
What is related to the toxic mega colon?
Ulcerative colitis.
110
What does the toxic mega colon look like on plain film!
Colonic diameter > 6 cm
111
Treatment for toxic mega colon?
Nasogastric suction, surgery
112
What is an anal fissure and how do the present? Treatment?
Linear shaped ulcer, posterior midline. (Off midline think Crohn's)
Typically arise from trauma. Present with severe tearing pain during defecation followed by throbbing pain. Hematochezia.
Treat with fiber supplements and sitz baths, topical anesthetics.
113
What is a perianal abscess and how does it present? Treatment?
Infected anal glands at the base of the dentate line. Presents with throbbing, continual perianal pain. Treat with I&d.
114
Describe a hemorrhoid, presentation and treatment.
Symptomatic as a result of activities that increase venous pressure. Presents with rectal bleeding, may protrude from anal opening. Pain with external rare with internal. Tx: high fiber diet, fluids, rubber band ligation, electro coagulation. Surgical excision.
115
What causes pilonidal disease?
Epithelial tissues trapped in I the natal cleft,, caused by infection of the hair follicle.
116
Treatment for pilonidal disease?
Good hygiene, surgery
117
Describe indirect hernia.
Passes from internal inguinal ring obliquely toward the external inguinal ring and into scrotum.
118
Describe direct hernia.
Protrudes outward and foreword and is medial to the internal inguinal ring.
119
What can cause secretory diarrhea?
E. Coli, salmonella, clostridium.
120
Describe infectious diarrhea. Clinical and epidemiology.
80% of acute diarrheal illness. Bloody diarrhea, abdominal pain, fecal WBC. Causes: food, abx, sex, daycare, hospitals.
121
Describe no infectious diarrhea.
20%, watery diarrhea! cramps abdominal pain! no fecal WBC. From Meds, fecal impaction.
122
Infectious diarrhea: e. Coli.
Fecal contam of food and water.
| Travelers diarrhea. Treat with bactrim or fluroquinolones.
123
Diarrhea: campylobacter.
Contaminated water or milk.
Self limited short duration.
Treat with azithro or fluroquinolones.
124
Diarrhea: salmonella
Contaminated eggs or milk.
Acute, self limited cramps abdominal pain.
No treatment.
125
Diarrhea: shigella
Fecal to oral.
Daycare, bloody diarrhea.
Treat with ampicillin or bactrim.
126
Diarrhea: giardia
Fecal contamination of water.
Wearer Bourne infection.
Treat with flagyl.
127
What causes pseudomembranous colitis!
Post antibiotics or chemo.
128
What bug is associated with pseudomembranous colitis?
C. Difficile
129
How do you treat pseudomembranous colitis?
Flagyl or vancomycin.
130
Describe a niacin deficiency.
Pellagra.
Due to diets high in corn and lack tryptophan.
Dermatitis, dementia, diarrhea.
131
What does thiamine deficiency cause (vit B1)?
Anorexia, muscle cramps, paresthesias, loss of reflexes. Treat with injections of vit b1
132
What does vitamin A deficiency cause?
Night blindness, xerosis, poor would healing. Treat with vitamin A.
133
What does riboflavin deficiency cause?
Neovascularization of cornea, dermatitis, Glossitis, cheilosis, angular stomatitis.
134
What does vitamin C deficiency cause?
Scurvy.
| Bleeding in upper thighs, bleeding gums from gingivitis. Due to poor diet and smoking.
135
What does vitamin D deficiency cause?
Rickets, osteomalacia, osteoporosis, muscle weakness. Treat with vitamin d.
136
What does vitamin K deficiency cause!
Bruising and bleeding. Treat with SQ vitamin K.
137
Describe lactose intolerance.
Lactase is a brush border enzyme that hydrolyzes lactose into glucose and galactose. If absent causes diarrhea, flatulance, and abdominal pain. Treat with lactase enzyme replacement.
138
What is phenylketonuria?
Hereditary dz, blue eyed blondes, deficiency of phenylalanine hydroxylase. After birth develop vomiting, irritability,it's, convulsions, mental retardation. Urine has musty odor. Screen 24 hrs after birth. Diet low in phenylalanine is treatment.
