GI Flashcards
(152 cards)
1
Q
Pt has wt loss, abdominal pain, and bleeding in stool?
A
colorectal cancer
2
Q
What is the best screening test for colorectal and when should it be done? What about family hx?
A
colonoscopy
50yo then q10yrs
if first relative had cancer –> 10yrs before dx and q5yrs
3
Q
What are RF for colorectal cancer?
A
family hx
smoking
hx of FAP (familial adenomatous polyposis)
4
Q
How to tx colorectal cancer?
A
do not use radiation - no effective
surgery i s needed
5
Q
Which family hx can lead to colorectal cancer?
A
familial adenomatous polyposis
6
Q
What is familial adenomatous polyposis?
A
MANY polyps
7
Q
When to start colonoscopy for FAP?
A
if known - 12yo
8
Q
How to tx FAP?
A
colectomy
9
Q
What are the two genetic colorectal cancer precursors?
A
FAP and hereditary nonpolyposis colon cancer
-autosomal dominant
10
Q
What are 2 different Lynch syndrome?
A
I- EARLY onset of CRC
II- early onset of CRC + other types of cancers in the body occurs (skin, stomach, etc)
11
Q
Pt has LLQ pain + fever + rebound tenderness + leukocytosis?
A
diverticulitis
12
Q
What are RF for diverticulosis?
A
low fiber diet
13
Q
Who are at risk for colorectal cancer?
A
IBD
14
Q
Where does diverticulosis mostly occur?
A
sigmoid colon
15
Q
Where is melena more common? -CRC
A
right sided colon cancer
16
Q
Where is hematochezia more common? -CRC
A
left sided colon cancer - blood
17
Q
How to dx diverticulitis?
A
CT scan - thicken bowel wall
18
Q
How to tx diverticulitis?
A
admit + abx: zoysn, unicin
outpt: cipro/flagyl
severe: surgery
19
Q
Pt is asian and has pain on RLQ?
A
diverticulosis
20
Q
Other sx for divertiuclosis?
A
usually asymptomatic
21
Q
How to dx diverticulosis?
A
barium enema IF needed
22
Q
How to tx diverticulosis?
A
increase fiber and exercise
23
Q
Pt has painless bleeding w/ urge to poop?
A
complication of diverticulosis
24
Q
How to tx diverticular bleeding?
A
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
