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Flashcards in GI Deck (152):
1

Pt has wt loss, abdominal pain, and bleeding in stool?

colorectal cancer

2

What is the best screening test for colorectal and when should it be done? What about family hx?

colonoscopy
50yo then q10yrs
if first relative had cancer --> 10yrs before dx and q5yrs

3

What are RF for colorectal cancer?

family hx
smoking
hx of FAP (familial adenomatous polyposis)

4

How to tx colorectal cancer?

do not use radiation - no effective
surgery i s needed

5

Which family hx can lead to colorectal cancer?

familial adenomatous polyposis

6

What is familial adenomatous polyposis?

MANY polyps

7

When to start colonoscopy for FAP?

if known - 12yo

8

How to tx FAP?

colectomy

9

What are the two genetic colorectal cancer precursors?

FAP and hereditary nonpolyposis colon cancer
-autosomal dominant

10

What are 2 different Lynch syndrome?

I- EARLY onset of CRC
II- early onset of CRC + other types of cancers in the body occurs (skin, stomach, etc)

11

Pt has LLQ pain + fever + rebound tenderness + leukocytosis?

diverticulitis

12

What are RF for diverticulosis?

low fiber diet

13

Who are at risk for colorectal cancer?

IBD

14

Where does diverticulosis mostly occur?

sigmoid colon

15

Where is melena more common? -CRC

right sided colon cancer

16

Where is hematochezia more common? -CRC

left sided colon cancer - blood

17

How to dx diverticulitis?

CT scan - thicken bowel wall

18

How to tx diverticulitis?

admit + abx: zoysn, unicin
outpt: cipro/flagyl
severe: surgery

19

Pt is asian and has pain on RLQ?

diverticulosis

20

Other sx for divertiuclosis?

usually asymptomatic

21

How to dx diverticulosis?

barium enema IF needed

22

How to tx diverticulosis?

increase fiber and exercise

23

Pt has painless bleeding w/ urge to poop?

complication of diverticulosis

24

How to tx diverticular bleeding?

colonoscopy w/ electrocautery - 1st line

25

When is barium enema and colonoscopy contraindicated?

diverticulitis

26

Pt has pain out of proportion? What is first line for imaging vs gold standard?

ischemic bowel disease
CT - pneumotosis intestinalis
exploratory is gold standard

27

What is the most common cx of ischemic bowel dz?

thrombi

28

What are RF for ischemic bowel dz?

age
CAD

29

What are the 3 phases of ischemic bowel dz and what are the sx?

hyperactive: severe pain
paralytic: NO pain but TENDER abdomen
shock: severe dehydration

30

How to tx ischemic bowel dz?

surgery

31

Pt has jaundice + asicties + hepatic encephalopathy? What would be labs would be elevated? How to tx?

cirrhosis
INCREASE IN ALK PHOS
lifestyle changes + liver transplant

32

What are cx of cirrhosis?

drinking
chronic hep B and C

33

Pathophys of cirrhosis?

irreversible chronic injury to hepatic parenchyma

34

Pt bilirubin is high, AST/ALT is greater than 2 and AST is high?

alcoholic cirrohsis

35

How to tx hepatic encephalopathy?

lactulose

36

How to dx cirrhosis?

liver bx

37

Pt has halitosis and spontaneous regurg of undigested food? How to dx?

zenker diverticulum
esophagram

38

Cx of zenker diverticulum?

UES is loose

39

Pt has dysphagia w/ solid AND liquids? What to expect on imaging?

achalasia
birds beak on esophagram-LES CANNOT relax

40

What is cx of achalasia?

loss of motility of distal 2/3 esophagus
LES CANNOT relax

41

How to tx achalasia?

botox
surgery

42

Pt has hx of suicide attempt w/ drain cleaner? What is next step?

caustic injury w/ alkaline burns
airway!
endoscopy after 12-24hrs to asses damage

43

Pt has dyspepsia after 30-60min of eating? What labs?

GERD
nothing

44

How to tx GERD?

PPI x4-8wks

45

Pathophys in GERD?

peristalsis and HCO3 does not neutralize pH

46

Pathophys of barrett's esophagus?

replacement of squamous epithelium w/ metaplastic columnar epithelium with goblet cells

47

Sx of barrett's esophagus? Tx?

NO sx
PPI

48

What is the most common cause of life threatening GI bleeding? Usually found in who?

esophageal varcies
alcoholics

49

What lab to do for all esophageal varices pts?

endoscopy

50

Tx for esophageal varices?

beta blocker
TIP
tx liver failure

51

What is cx of esophageal varices?

portal HTN

52

Pt has been throwing up for 3hrs? Pathophys?

mallory wiess tears
longitudinal mucosal tear

53

How to tx mallory wiess tears?

vasoconstriction and cautery

54

Pt threw up and now has SEVERE upper abdominal pain + restrosternal chest? What is happening and what to do?

boerhaaves sx
sponatenous perforation
RESUSCITATE

55

What lab to run w/ boerhaaves sx?

CT
esophagram
endoscopy

56

Pt smokes and overtime has difficulty swallowing food?

esophageal cancer

57

Pathophys of esophageal cancer?

squamous cell and adenocarcinoma - distal 1/3 esophagus

58

What is caput medusae?

distention of abdominal wall veins

59

What PE for pts with hepatic encephalopathy?

asterixis

60

Pt has yellowish rings/sunflower on eye (name?) + resting tremor? What organ is affected? Gold standard?

kayser fleischer rings
wilson dz
liver, CNS, renal affected
liver bx

61

Pathophys of wilson dz? Cx?

too much copper b/c of deficiency of ceruloplasmin (needed to excrete copper)
ATP7B

62

How to tx wilson dz?

zinc

63

What are the liver dz that are autosomal recessive?

wilson dz
hemochromatosis

64

Pt is tired and arthralgia - what screening exam should be done?

iron

65

What is hemochromatosis? What is the cx of death?

iron overload
cardiac fialure

66

How to tx hemochromatosis?

phlebotomy

67

Pt that is otherwise healthy has liver failure? What will imaging show?

nonalcoholic steatohepatitis
fatty liver on image

68

Pathophys of NASH? Tx?

fatty liver that is inflamed and damaged
lifestyle changes since pts are usually fat

69

What are 3 major causes of jaundice?

hemolysis
liver dz
biliary obstruction

70

Conjugated vs unconjucated?

direct - water solube and NOT bound to albumin
indirect- NOT water soluble - passes BBB: TOXIC; bound to albumin

71

Dark urine - conjugated or unconjugated?

conjugated

72

Which is better for liver damage- AST/ALT?

ALT

73

Where is AST found?

liver and OTHER organs

74

ALT/AST is mild high?

chronic viral hep
acute alcoholic hep

75

ALT/AST is mod high?

acute viral hep

76

ALT/AST is VERY high?

ischemia, shock liver
acetaminophne tox

77

If ALT/AST is high in general?

Autoimmune hep
hep B, C
Drugs
Ethanol
Fatty liver
Growth (tumor)
Hemodynamic (CHF)
Iron, copper

78

If Alk phos is high, what other lab should do? Why?

GGT; make sure its a liver prob

79

Why is alk phos high?

if biliary is obstructed -but NOT specific to liver

80

What are the RF for cholelithiasis?

Fat
Forty
Female
Forty
Fertile

81

How to tx biliary spasms?

levsin

82

How to tx cholelithiasis?

cholecystectomy
avoid coffee, OJ, nuts, statins

83

Is cholelithiasis common?

yes but asymptomatic most of the time

84

Pt has fever + RUQ pain and mid-back to rt scapula + leukocytosis? What PE should be positive? Does movement affect pain?

acute cholecystitis
murphy's sign
yes

85

How to tx acute cholecystitis?

surgery

86

Pt has RUQ pain after eating? Can patient move around? What imaging is used to dx and what labs will be elevated?

cholelithiasis
yes-pain does not worsen with movement
US
labs: ALT/AST and alk phos is high - confirm w/ GGT

87

Diff between cholelithiasis and acute cholecystitis?

cholelithiasis: can be asymptomatic; gallstones are present but not aggravating anything
acute cholecystitis: more pain w/movement and (+) murphy

88

Pt has RUQ pain + jaundice+no fever? How to differentiate-1st line? Gold standard?

1) cholelithiasis 2) acute cholecystitis 3) choledocholithiasis
US - r/o cholelithiasis and acute cholecystitis
gold standard - ERCP (dx and tx)

89

What is charcot triad?

RUQ pain + jaundice + fever
acute cholangitis

90

What is reynold's pentad?

charcot triad (RUQ pain + jaundice + fever) + confusion + hypotension (shock)

91

What are sx of acute cholangitis? How to differentiate (1st line)?

charcot triad (RUQ pain + jaundice + fever)
reynold's pentad (Charcot triad + confusion + hypotension)
US to r/o choliethiasis, acute cholecystitis, and choledoclithiasis

92

How to tx acute cholangitis?

admit + abx + surgery (ercp)

93

Pt has pruritis + jaundice + exoriations + hepatosplenomegaly? Test of choice?

primary sclerosing cholangitis
MRCP

94

What is primary sclerosing cholangitis vs choledocolithiasis vs acute cholangitis?

primary sclerosing cholangitis - INFLAMMATION (idiopathic) of bile ducts; NO STONES
choledocolithiasis - stones in biliary duct
acute cholangitis - BACTERIAL INFXN of the biliary tract

95

Pt has epigastric pain -> umbilicus -> RLQ pain and NOT hungry (anorexia)? What PE should be positive?

acute appendicitis
mcburney's
rovsing
psoas
obturator

96

How to tx acute appendicitis?

appendectomy

97

How to dx acute appendicitis-PE, lab, image?

PE: rovsing, psoas, and obturator
lab: high WBC
image: CT

98

Pt has abdominal pain that goes to the back; fetal position makes pain better? What PE should be positive?

acute pancreatitis
cullen and turner signs

99

What labs to run for acute pancreatitis and how to find cx?

lipase is better than amylase but both are high
ALT/AST, alk phos can be used to r/o gall stones as cx for acute pancreatitis

100

What are cx for acute pancreatitis?

gallstone
alcoholism

101

How to dx acute pancreatitis?

KUB -1st line
CT

102

How to tx acute pancreatitis?

mild - self limiting, IV and pain control
severe - admit to ICU but still self-limiting

103

What criteria can be used in acute pancreatitis?

ranson

104

Pt has abdominal pain that goes to the back and worsens AFER drinking? What is next step - lab/imagine?

chronic pancreatitis
lipase and amylase -normal
CT

105

How to differentiate chronic and acute pancreatitis?

labs for lipase and amylase in acute is high but chronic is LOW

106

How to tx chronic pancreatitis?

self limiting
resection

107

Pt smokes, pruritis, sudden jaundice, clay stools, and gnawing visceral pain? What PE should be positive?

pancreatic cancer
courvoiser sign -large non painful GB
trousseau -glucose intolerance, venous thrombosis, migratory throbmophlebitis

108

How to dx pancreatic cancer?

US then upper GI series
bx is best

109

GERD complication?

barrett esophagus

110

Pt w/ barrett esophagus is at risk for?

adenocarcinoma

111

How to differentiate between esophageal cancer and achalasia?

esophageal cancer: dysphagia w/ solid THEN liquid
achalasia: BOTH solid and liquid

112

How to tx Zenker diverticulum?

surgery

113

Pt takes NSAIDs and has epigastric pain + N/V? Next step - if pt is 55yo?

peptic ulcer dz
55yo: endoscopy

114

How to tx peptic ulcer dz?

remove NSAIDs
if h pylori is positive: triple or quadruple therapy
-PPI + 2abx
H2 blockers

115

Pt is asian + recurrent h pylori infxn? Tx?

gastric cancer
surgery to excise

116

When do you refer pt to specialist?

GERD that doesnt resolve
barrett esophagus

117

Pt has dyspepsia, heartburn, regurgitation, and waterbrash? What labs to order?

waterbrash: hypersalivation
labs: 55yo endoscopy

118

Complication of GERD?

barrett esophagus

119

Pt has abdominal distention and no stool/gas? What to expect on PE?

bowel obstruction
high pitched tinkling bowel sounds
DEHYDRATION

120

How to tx bowel obstruction?

incomplete: outpt- fluids and NG tube
complete- inpt: NPO, pain control, surgery

121

What image to order for bowel obstruction?

xray - bowel loops

122

What is cx of bowel obstruction?

procedure and adhesion occurs

123

What is ileus?

no motility of GI

124

Pt has chronic recurrent abdominal distention + N/V- what lab to order to r/o what and what would you expect to see?

r/o bowel obstruction
expect - nothing if pseudoobstruction

125

Pt has bloody diarrhea, abdominal pain, fever?

toxic megacolon

126

What are the two types of IBD?

UC and Crohn

127

How to differentiate between UC and Crohn via image and sx?

UC- NO skipped lesions; rectum and colon
Crohn- skipped lesions
UC - bleeding diarrhea
Crohn- no bleeding diarrhea

128

Labs for UC?

high c reactive protein and platelets and ESR
LOW hemoglobin d/t bloody diarrhea
OVA -r/o any bacterial infxn

129

How to tx UC and Crohn

sulfaslazine and 5ASA

130

Pt was recently dx with anemia and has replapsing and remitting diarrhea? What lab should be done?

celiac dz
igA

131

How to tx celiac dz?

avoid gluten

132

Pt has diffuse intermittent abdominal pain but no structural abnormalities, gets better after defecation; and has been recently dx with fibromylagia?

IBS

133

What criteria is used for IBS?

rome criteria: >3days/1mo for 3mo

134

How is Hep A and E transmitted?

fecal oral

135

How is Hep B transmitted?

parenteally or sexually

136

How is Hep C transmitted?

parenterally

137

Which Hep can progress to chronic dz?

B, C, D

138

What are the phases of Hep?

prodromal pahse
icteric phase
recovery phase

139

How to dx Hep A?

acute - IgM
chronic - IgG

140

How to tx Hep A?

self-limiting

141

Which Hep have vaccines?

Hep A
Hep B

142

Do pts with Hep A have jaundice?

yes- when the viral shedding slows down

143

What is the incubation time for Hep A?

4wks

144

If pt w/ Hep B has liver transplant, what could hap?

extraheptic reservoirs - virus is in lymph nodes, bone marrow, spleen --> reinfxn can occur

145

What test should be used in testing ACUTE hep B?

HBsurface Ag - but undetectable 1-2 mo
HBcore Ag to detect during the window

146

What is the diff for IgM and IgG in hep B?

IgM is CURRENT infxn w/i 6mo
IgG infxn LONGER than 6mo

147

What should be used for f/u in chronic hep B?

HBeAg

148

ALT or AST high in hep?

ALT

149

How to tx hep B?

self limited

150

How to dx hep C?

HCV RNA - gold standard

151

How to tx hep C?

interferon alpha monotherpay

152

Pt is hemophiliac and drug user-at risk for?

Hep B and D