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Flashcards in GI Deck (192):
1

Zenkers diverticula

is a pouch in the mucous of the pharynx, just above the cricopharyngeal muscle

2

Symptoms of Zenkers diverticula?

regurgitation

3

Odynophagia

painful swallowing

4

Goal standard to dx Barretts?

Endoscopy with biopsy

5

Cell change of Barretts

Sqamous to columnar cells --causing adenocarcinoma

6

Tx of GERD?

1. antacids 2. H2 blockers (ranitidine) 3. PPIs (omeprazole) and Nissen

7

Infectious esophagitis --you should think?

immunocompromised (HIV)

8

findings on PE for infectious esophagitis?

Ulcers

9

Deep esophageal ulcers

Herpes

10

Swallow esophageal ulcers

CMV

11

Esophageal achalasia

Esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus

12

gold standard test for Esophageal motility disorder

24 hour manometry and barium swallow

13

Medication for Esophageal motility disorder

CCB (nifedipine) and pro kinetics (metoclopramide) to help with emptying of the stomach in people with delayed stomach emptying.

14

main etiology of esophageal varies?

Portal HTN / cirrhosis

15

which has greater bleeding Mallory Weiss tear or Boeehaave's?

Boehaaves- is rupture of the esophagus. May have Hamman's sign=crunch of crepitus in the pericardium

16

#1 cause of esophageal strictures?

GERD, can also be infection or autoimmune

17

why does caffeine and smoking lead to GERD?

decreases esophageal tone

18

which would you not find in nephrotic syndrome Hematuria or Hyperlipidemia?

No Hematuria!!!

19

Ulcer that is worse right after eating

peptic

20

ulcer that is better after eating

duodenal

21

gold standard to dx ulcers

endoscopy with biopsy

22

how do you eradicate h.pylori

triple antibiotic therapy

23

go to med for tx of ulcers

H2 blocker and PPI

24

at what age is pylori stenosis most common

4-6 week old baby

25

string sign

think pylori stenosis

26

the four f's of cholelithasis

fat, forty, female, fertile

27

good standard of imagining for gallbladder

US

28

If a patient has dermatitis herpetiform, they also have?

celiac disease

29

define anorexia nervosa?

15% decrease from their ideal body weight

30

medical therapy for anorexia

antidepressants, mood stabilzers

31

what vitamins are higher risk for toxicity>

fat soluble (ADEK) storage in the attic

32

Thiamine is?

B1

33

4 reasons why someone may have a thiamine deficiency

1. ETOH
2. Hyperemesis gravidarum
3. malignancy
4. AIDS

34

why must you give thiamine before dextrose ?

prevent wernicke's encephalopathy

35

what is the difference between WET beriberi and DRY beriberi

WET: blood:CVS and leads to cardiac failure
DRY: CNS peripheral neuropathy that can lead to Wernicke's and finally to Korsakoff

36

Name the 3 components of wernicke's

1. confusion, ataxia, and opththamoplegia

37

opththamoplegia

paralysis of the muscles within or surrounding the eye, this is CN 6

38

name 3 components of korsakoff?

irreversible, short term memory loss, and CONFABULATION

39

symptoms of B3 (Niacin) deficiency

Pellagra: the 4 D's
1. Dermatitis
2.Diarrhea
3. Dementia
4. Death

40

treatment for fissures

surgery

41

Tx for perianorectal abscess

I&D, antibiotics

42

Two precursors of anal cancer?

Papillomarvirus and HIV, most common type is squamous

43

why does esophageal CA spread to mediastinum?

the esophagus has no serosa

44

best test to stage esophageal CA?

Endoscopic sonography and CT

45

what is Budd Chiari syndrome

thrombosis of the portal vein leading to esophageal varices

46

are varices symptomatic

no not until they bleed, then they become life threatening

47

tx for varices? medical and surgical

beta blockers, stop hepatotoxic agents and use band ligation

48

medications that worsen GERD

NSAIDs, antibiotics, CCB, benzos, iron, anticholinergics

49

acute varices bleeding tx

band and use octretide

50

what two test can be used to test if h.pylori has been eradicated with triple antibiotic treatment?

the stool antigen test and urea breath test. The serum antibody test can be used to detect, but does not test for a cure

51

triple antibiotic therapy for h. pylori

amoxicillin, clarithromycin and metronidazole

52

what is zollinger ellison syndrome

gastrin secreting tumor (gastrinoma) causes refactory PUD

53

gastrinomas can be part of what syndrome?

MEN 1

54

how to dx gastrinoma

fasting gastrin level greater than 150 and a secretin test (give 2units and the gastrin level will increase more than 200 units

55

what is the most common CA in the world

Gastric adenocarcinoma

56

sign of metastatic gastric cancer

umbilical node (sister mary joseph) and left supra clavicle node (Virchow)

57

the stomach is the most common extra nodal site for what CA?

non Hodgkin lymphoma

58

pseudomembranous colitis (think)

c.dif

59

small bowel obstructions are caused by

adhesions

60

larger bowel obstructions are mostly caused by

CA

61

treat for bowel obstructions

partial: NPO, IV fluids, nasogastric suctioning
complete: surgical

62

location where volvulus most often occur?

cecal and sigmoid area

63

tx of volvulus

try endoscopic decompression or surgery

64

dx of celiac

IgA antiendomysial and anti tissue transglutaminase antibodies for screening. Small bowel biopsy is needed to confirm the dx

65

complications of crohns

fistulas, abscess, aphthous ulcers, renal stones, granulomas

66

dx of crohns

colonscopy is the most valuable tool for establishing the dx.

67

acute crohns attack is tx with?

oral steroids (prednisone)

68

is surgery curative with crohns or UC

UC(segmental resection is possible, but total proctocolectomy is the most common

69

where does UC start?

distally, at the rectum and progresses proximally

70

are toxic mega colon and CA more common with UC or crohns?

UC

71

name the skin manifestations associated with UC

erythema nodosum and pyoderma gangrenosem

72

is smoking protective of harmful with UC

protective

73

dx

colonscopy of sig, but not during acute disease

74

what is the most common cause of chronic or recurrent abdominal pain the US

IBS

75

population that gets intussusception?

children and most likely post viral

76

tx of intussusception in children vs adults

barium enema for kids, surgery for adults

77

dx of intussusception

CT

78

can fever and leukocytosis occur with diverticular dz

yes

79

tx for diverti

antibiotics, hospitalization for IV antibiotics, bowel rest, pain meds and nasogastric suction

80

what will patient's of both acute and chronic ischemic bowel be?

over the age of 50 and have signs of CV or collagen vascular dz

81

dx of ischemic bowel?

duplex US of the mesenteric artery, confirmed by angiography

82

tx of ischemic bowel

hydrate and operate

83

describe acute ischemic bowel

pain out of proportion with exam

84

describe chronic ischemic bowel

pain 10-30min have eating, relieved by squatting or lying down

85

name four disorders that can cause toxic mega colon

UC, Crohns, pseudomembranous colitis, and infectious bugs

86

X-ray finding for mega colon

colonic dilation

87

tx mega colon

decompression is required or colostomy may be required
watch electrolytes

88

toxic mega colon in newborns

hirschsprung; congenital aganglionosis of the colon

89

how often should family members of familial polyposis syndrome be evaluated

1-2 years beginning at age 10-12

90

out of hyper plastic, tubular and villous which is the highest CA risk

villous, then tubular, then hyper plastic

91

follow up if multiple hyper plastic or tubular is found

5 years

92

if villous is found, follow up?

3 years

93

top 3 leading cancer deaths in the US

1. lung cancer 2.skin 3. rectal

94

right sided colorectal lesions cause

chronic blood loss, iron deficiency anemia, but obstruction is uncommon

95

left sided colorectal lesion cause

are circumferential causing change in bowel habits and obstructive symptoms

96

what is carcinoembryonic antigen used for

to monitor colorectal CA-not to dx

97

what are pilonidal cyst

abscess in sacrococcygeal cleft associated with a subsequent sinus tract development

98

tx anal fissure

sits bath, silver nitrate cream

99

tx for abscess vs. fistula

abscess (I&D) and fistula(surgical)

100

more proximal fecal impaction may indicate

neoplasm

101

Anal CA is caused by

HPV

102

screening of anal cancer can be done?

pap smear

103

the most common abdominal surgical emergency

appenidix

104

appendicitis is most often caused by

fecalith , but can be caused by CMV or another virus

105

WBC expected by appendicitis

10,000 to 20,000 (anything higher think perf)

106

acute pancreatitis is caused by

ETOH, gallstone, hyperlipidemia, drug(antiHIV), hypercalcemia

107

where are pancreatitis pain radiate?

to the back

108

dx testing for pancreatitis?

lipase is more sensitive and specific than amylase, use Ranson's criteria, look for gallstones on US

109

X-ray finding for pancreatitis

sentinel loop

110

tx for acute pancreatitis

STOP all oral intake to prevent continued secretion of pancreatic juices, maintain fluid volume, control pain

111

chronic pancreatitis contributed 90% of the time to

ETOH, must stop this to get better

112

stool symptoms of chronic pancreatitis

increased fecal fat due to malabsorption that lead to steatorrhea

113

what will X-ray show in chronic pancreatitis

calcification

114

Signs of pancreatic cancer?

Jaundice, palpable gallbladder (courviouser's sign) tx is a whipple and prognosis is poor

115

do all people with gallstones develop symptoms

no, only 30%

116

what are the complications of gallstones

cholecytitis, pancreatits, and acute cholangitis

117

symptoms of acute cholecysitis (blockage of the cystic duct)

colic, epigastic pain, after a meal, right shoulder radiation, N/V, constipation. BUT NO JAUNDICE (unless the stone has migrated in the common duct area)

118

dx cholecystitis

US, hepatoiminodiacetic acid (HIDA scan) and endoscopic retrograde cholangiopancreatiography )ERCP can id, locate, and note the extend of the obstruction

119

what is acute cholangitis

an obstruction(gallstone or CA) of the common bile duct that is complicated by infection caused by ecoli, kleb or enterobacter

120

what is charcot triad

fever, RUQ pain, and jaundice

121

what is fever, RUQ pain, jaundice, mental status change, and hypotension called

Reynolds pentad. it indicates sepsis

122

dx of acute cholangitis

US, WBC shift and ERCP (dx and treatment)--for drainage, surgical sphincterotomy and stone removal and stent placement once pt is stable. give antibiotics. The gallbladder should be removed once pt is recovered

123

antibiotics for acute cholangitis

fluoroquinolone, ampicillin, gentamicin or metronizole

124

what is primary sclerosing cholangitis

chronic thickening of the bile duct walls 80% of cases are associated with UC.

125

primary sclerosing cholangitis is associated with UC and _______________

cholangiocarcinoma, pancreatic cancer, and colorectal cancer

126

Jaundice, pruritus, weight loss are common symptoms of

PSC

127

tx for PSC

use balloon dilation for stricture and stent placement, LIVER transplant is the only tx with known surivial benefit

128

most common cause of acute hepatitis?

VIRAL, etoh is second

129

bilirubin greater than 3.0 is associated with

scleral icterus

130

chronic hep most often results from viral infection of what letters

B,C,D

131

A&E hep are transmitted by? course?

fecal oral, self limiting and mild

132

B, C, D hep are transmitted? course?

needle and mucous membrane

133

hep D is only seen in conjunction with

hep B (more severe course)

134

dx for hep

aminotransferase elevations, bilirubin increase

135

marker for Hep A at initial incubation period and then several months later

1. initial = IgM antibody (anti-HAV)
2. resolved infection = IgG

136

marker for ongoing Hep B infection

Hep B surface antigen (HBsAg)

137

marker that indicates immunity by past infection or vaccination to hep B

(Anti-HBs) the person has form an antibody against the surface antigen of HB

138

what does HBeAg indicate

hep b envelope antigen (HBeAg) indicates infection that is highly contagious

139

what does anti-HBe indicate

lower viral titer

140

how do you tell the difference between the carrier state or hep b and the chronic infection of both are positive for HBsAg

in chronic infection there will be liver damage, increase AST and ALT. the viral load will be greater than 10 to the 5th copies

141

toxic hepatitis can be caused by acetaminophen overdose, what is the recommended amount per day and tx?

4g and acetylcysteine

142

two biggest causes of cirrhosis

ETOH and Hep B or C

143

spontaneous peritonitis present with cirrhosis, this can lead to

diarrhea and renal failure, this can be treated with antibiotic

144

Dx for cirrhosis

normal labs until late in the disease. CT, US and MRI will show nodules and helpful in grading biopsy

145

what is cirrhosis?

irreversible fibrosis and nodular regeneration throughout the liver

146

what medication can be given for ascites

diuretic

147

bacteria that usually causes liver abscess

entamoba histolytic or the coliform bacteria

148

primary hepatocellular carcinoma is associated with

hep B & C, cirrhosis

149

tx of liver cancer

do not do needle biopsy (seeding), only resect if contained to one lobe, if this is a second CA, then tx the primary

150

what lab may be elevated to help with liver CA dx?

alpha-fetoprotein

151

incisional hernias are associated what type of incision

vertical

152

ventral hernia

a weakening in the anterior abdominal wall

153

congenital diaphragmatic hernia of newborn is dx and tx ?

cause respiratory distress due to pressure of hernia on lungs, intubation, nasogastic suction tx is surgical. Dx is made on hearing bowel sounds in the chest, x-ray shows loops of bowel involved in the hemithorax, displacement of the heart and mediastinal structures

154

Phenylketonuria is a

rare autosomal recessive inability to metabolize protein phenylalanine (it accumulates in the CNS and causes dehydration. strict control of protein is required throughout life.

155

lack of vitamin C causes what symptoms?

perifollicular hemorrhage, ecchymoses of the legs, bleeding gums, loose teeth and GI bleeding

156

Interferon (tx for hep) is contraindicated in patients with?

autoimmune disease, severe liver dz and cardiac arrhythmias

157

large volume of watery diarrhea

Ecoli or a virus

158

smaller volume, but bloody diarrhea

is infection with Samonella, Shigella, C. dif or Camp

159

chronic diarrhea from cryptosporidiosis may be indicative of

immunodeficiency (HIV)

160

CT finding of diverticulitis

soft tissue thickening of the pericolic fat and a thickening of the bowel wall

161

Markle sign or jar sign

rebound tenderness, pt stands and drops heels to the ground

162

Pellagra is what type of deficiency

Niacin

163

3 D's of pellagra

dermatitis, diarrhea, and dementia

164

mechanical impaction is treated

manual disimpaction

165

are anal fissure seen in both UC and crohns

no only Crohns

166

what is seen on X-ray of perforated ulcer

free air under the diaphragm

167

pain during defecation with occasional blood on TP

anal fissure

168

factors that contribute to stress ulcers forming the first 72 hours of hospital stay

critical ill, burns, trama and sepsis

169

where are femoral hernias palpated

below the femoral ligament

170

is primary biliary cirrhosis associated with direct or indirect bilirubin

direct

171

acute onset of LUQ pain that radiates to the back and mid-epigastric is tender to palpation, vomting, fever, and tacky pulse

pancreatitis

172

tx for mild to mod ulcerative pancolitis

sulfasalazine

173

most common travelers diarrhea is adults

E. coli

174

how to test for giardiasis ( the most common intestinal protozoal infection in children in the US)

ova and parasite in stool or the giardia antigen in the stool

175

putum cultures revealing Mycobacterium tuberculosis are the gold standard in diagnosis of pulmonary TB. Typically sputum samples are obtained in the morning on three consecutive days.

bismuth (Pepto-Bismol) coats the stomach and inhibits pepsin action.

176

Which of the following types of anemia may be present in patients with Celiac disease?

Iron deficiency anemia

177

Which of the following is the definitive therapy in an infant whose rectal biopsy reveals absence of ganglion cells?

Colostomy or resection of the aganglionic segment is the definitive therapy for an infant with Hirschsprung’s disease.

178

Which of the following antibiotic regimens is indicated in the treatment of a patient with cholecystitis?

Ceftriaxone and Metronidazole

179

Which of the following is the most common cause of gastric outlet obstruction?

cancer

180

he patient undergoes colonoscopy as part of the evaluation, which shows irritation and mild ulcerative lesions in the terminal ileum as well as the splenic flexure. Both lesions appear to have a cobblestone-like pattern to them. Which of the following is the most likely diagnosis?

crohn's dz

181

Which of the following is the antibiotic of choice for an adult patient with stool positive cultures indicating Shigella infection?
A.

Ciprofloxacin

182

What is the appropriate treatment for volvulus?

Rigid/flex sigmoidoscopy

183

infant’s vomit as bilious. You immediately order a KUB radiograph which reveals ‘double bubble sign’ and confirms your diagnosis of which of the following?

Duodenal atresia

184

Which of the following is the next step in the management of a patient who has elevated bilirubin levels on his routine annual lab work and a history of Gilbert’s syndrome?

This is a congenital disease that often goes undiscovered for many years. In this condition, the patient’s liver has a difficult time processing bilirubin. This is completely benign and will resolve on its own, no medical therapy is necessary, and patients should be provided with reassurance.

185

A 56 year old male presents to the emergency department due to altered mentation and confusion. Physical exam reveals hyperreflexia and cerebellar ataxia. You also notice a musty breath odor and the patient has a positive asterixis sign. Which of the following medications would be most appropriate at this time?

This patients has a history consistent with hepatic encephalopathy. The primary toxin associated with this condition is ammonia. Lactulose functions to lower levels of ammonia in the blood.

186

Which of the following best describes the term "tenesmus"?

Rectal urgency and straining in an empty colon

187

preferred imaging for possible blow out fracture?

CT

188

what is a positive asterixis sign?

wrists in extension, provider pushes further into extension, causing a flapping the fingers (THE FLAPPING TREMOR)

189

name two conditions with a positive asterixis sign

renal and hepatic encephalopathy

190

hepatic encephalopathy symptoms

hyperreflexia, positive asterixis sign, cerebellar ataxia, confusion

191

toxin involved in encephalopathy?

ammonia toxicity. Tx is LACTULOSE

192

Which of the following Vitamin deficiencies is most likely to present with poor wound healing?

vitamin C