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GI Flashcards

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1
Q

Tongue -

Sensory?
Taste?
motor?

A

Sensory - 5-9
Taste 7-9
Motor 12

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2
Q

Esophageal lymph node sections?

A

Cervical;
mediastinal
celiac/gastric

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3
Q

Types of mouth CA

Pleomorphic adenoma

Warthin

Mucoepidermodi

A

Pleomorphic adenoma - benign - “Chondromyxoid” - Odd borders, Recurrs after surgery.

Warthins - Bening, Cystic w/ GERMINAL CENTER. Papillary cystic.

Mucoepidermal - Malig - Mucous+ Squamous

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4
Q

Torus palatinus - Presentation? Tx?

A

hard midline immobile mass in superior palate.

No tx unless sx

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5
Q

Retropharyngeal abscess - Radiographic findings?

Concerns?

A

Widened prevertebral space -> concern mediastinal infection

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6
Q

Leuk/Erythroplakai?

What to do? Concners?

A

Biopsy both. NOT SCRATCHABLE off

E> L risk factor for SQUAMOUS CCA

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7
Q

Esophageal perf - dx?

A

Water soluble esophagram.

May be iatrogenic, after biopsy

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8
Q

Ludwig Angina -location, from where?

A

Submandible, sublingual - from molars.

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9
Q

Toxic ingestions - workup algorithm?

A 
Serial CXR (for perth)
Endoscope w/in 24 hours -
Follow up sx w/ water sol esophagram
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10
Q

Variceal Hemorrhage - Tx algorithm?

A

IV fluids, octreotide, Ceftriaxone. BB is long term

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11
Q

Mallory weight etiology of tear?

A

Submucosal artery at distal esophagus, proximal stomach

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12
Q

Duodenal hematoma tx?

A

NG and TPN - no abx

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13
Q

Causes of acute gastritis?

A

UREMIA, Stress, NSAIDS, ETOH, Burn, Brain.

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14
Q

Chronic Gastric - location and etiology. Risk factors?

TA
TB

A

A - Fundus, Body, Autoimmune

B - Antrum - Bacterial. INC risk of MALToma (tx h pylri) ADENOCA.

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15
Q

Menieres - presentation?

Concerns?

A

Hypertrophy, protein loss. INC mucous, DEC parietal cells.

Premalignant

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16
Q

Peptic Ulcers - Locations? Types? Locations

A

90% duodenoal (ok), Gastric are the concerns

intestinal - Lesser curve - H pylori - Chronic Type B
Diffuse - non H pylori. SIgnet. Linnus plastic. Krukenberg

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17
Q

VIPoma - locations?

Vs

Carcinoid?

A

VIPoma - pancreas

Carcinoind - Ileum/small bowl

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18
Q

Dumping syndrome? When? Presentations?

Tx?

A

Autonomic signs, flushing, fainting,

Occurs post gastrectomy>

Change Diet first.
Refractory -> Octreotide -> surgery

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19
Q

Sites of Fe, Folate, B12 abs?

A

Fe - duodenum
Folate - Jej
B12 - ileum

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20
Q

Acute mesnteric Ischemia - lab findings?

A

INC lipase, INC lactate, METABOLIC ACIDOSIS.

AKA can mimic pancreatits . Look for athero risk factors

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21
Q

Chronic mesenteric ischemia presentation?

A

Worse wi th food. 50% have abd bruit

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22
Q

Chronic pancreatitis - presentation?

A

Pain with no relief from antacids . Intermittent pain.

Dx - CT scan - may show calcifications

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23
Q

Trousseau sign - presentation, etiology, concnerns

A

Mig thrombophlebitis, Hypercoag state.

Pancreatic CA.

CT Abd.

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24
Q

Pancreatic CA screening biomarker?

A

CA 19-9

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25
Crohns vs UC
Crohns -Th1, granulomas, creeping fat, kidney stones. tx - steroids, MTX, infliximab UC - No granulomas (Th2) - Lead pipe sign, PSC, P ANCA - Tx 5ASA, 6MP, Inflix, Colectomy
26
Tx IBD related toxic megacolon?
Abx + STEROIDS
27
P biliary Cirrhosis VS P Sclerosing CHolangitis
PBC - Crohns, granulomas, female night, pruritis. - INTRA hepatic. Vanishing duct, ductopenia - Anti-Mitochondrial - Crest, sjogrens, Celiac, RA - Tx ursodeoxycholic PSC - Fibrosis, onion skinning, beading. - p ANCA - Intra and extra hepatic - ~Hyper IgM, UC, CHOLANGIOCA
28
Dx and histo Lactose vs Celiac -- risk?
Lactose - normal villi - H breath test, INC stool reducing agents, DEC stool pH. INC osmotic gap Celiac - blunted villi. Ab - TTG, gliadin, endomysial. Dq28, TH mediated. - Riks - T CELL LYMPHOMA
29
Tropical sprue - similar to ? tx?
Celiac -- responds to abx though
30
Abeta - histo presentation?
Abeta - fat in enterocytes. DEC APoB Night blindness, steatorrhea, ATAXIA
31
Pancreatic insufficiency - dx?
D -xylose test ( doesnt need enzymes to be abs)
32
How to test for ZE, gastrinoma?
Secretin test. Usualyl it shoudl DEC gastring. But in ZE it INCREASE gastrin.
33
Small bowel bacterial overgrowth - presentation? dx?
Malabs, steatorrhea, bloating, flatulence, weight loss Anatomic dysmotility. Jejunal aspirate shows >10^5 microbes.
34
Schilling test - pathways and findings
B12 abs 1 - IM + PO = if in urine - dietary. If not in urine, was not abs 2 - PO + IF -in urine = pernicious anemia not in urine - ileal disease.
35
Who to suspect pernicios anemia in?
Northern European w/ autoimmune conditions (vitiligo, thyroid etc)
36
Polyps to be concerned w? 3 factors
Villous, Sessile (no stalk) , Greater than 2.5cm
37
FAP - inheritance, chr, gene problem special subtypes
FAP - AD, APC, Chr5, Gardeners - FAP + osseous Turcot - FAP + Malig CNS
38
HNPCC lynch - genetic problem - concerns?
DNA mismatch - R colon - Extrainteestinal CA! (endometriod)
39
Peutz Jegher - inheritance - presentation - cocners.
AD - Nonmalig hamartomas + hyperpig. INC CRC risk !! (as a whole, not from hamartomas)
40
Watershed sites in colon?
Splenic flexure Rectosigmoid
41
Liver microvesicular vs macro? centrilobular?
Microvescular - reyes Macro - ETOH, Nash, N! Mallory bodies Centrilobular necrosis - halothane
42
Damage in hepatitis is from?
Cytotoxic T lymphocytes
43
In clearance phase, how to monitor hepatitis?
e Ag and ALTs every 3-6 mo until cleared
44
Hep B tx - when? with what?
DNA>20k, ALT x2 Short term - interferon (but really, Tenofovir!) chronic - Tenofovir, entecavir
45
Hep C - tx? requirements?
Compensated (fibrosis is okay) Older than 18, INR less than 1.5, compliant. No active drug use or MDD. peginterferon + ribavarin geno1 add telaprevir, boceprevir iF UNCOMPLICATED (inr > 1.5, DEC serum albumin -> liver tx)
46
Hep C associated with what 4+?
Porphyria, cryoglobulinemia, Memb, Memprolieratve T1
47
Etiology, tx, concerns. Cavernous hemangioma - Hepatic adenoma Angiosarcoma?
Cavernous hemagnioma - common, benign, DO NOT BIOPSY Hepatic adenoam - OCP/steroids Angiosarcoma - Arsenic, vinycl Cl, PECAM 31.
48
Gilbert Crig Najr Dubin HJohns Rotor
Gilbert, DEC UGT - largely asx Crig Najr - T1 - NO UGT - plasmapx, photo Crig Najr 2 - Not as bad - Tx phenobarbital Dubin Johnson - DEC ability to excrete - INC Cbili, BLack liver Rotor - INC Cbili, no black liver
49
Cirrhosis - maintenance workup?
US and AFp every 6 mo EGD every year
50
Hepatorenal - etiology, presentation?
ESLD -> renal failure due to renal hyoperfusion. Urine Na is less than 10 (good, prerenal picture) Not corrected with IV fluids.
51
Acute liver failure - presentation? causes? best prognostic factor?
Encephalopathy, INR>1.5 WITHOUT PREEXISTING CIRRHOSIS Hept, ETOH, tylenol, ischemic, wilsons May see a dec in Transaminase (dec liver function) PT is best prognostic factor
52
WIlsons lab findings?
DEC ceruloplasmin INC Cu urine excretion (only way to get it out)
53
TPN - most feared complication. Other concerns.
catheter tip infection. Diarrhea is rare. Avoid Refeeding syndrome(HypoK,Mg, P ) by slow infusion and checking electrolytes.
54
What should be given to someone s/p gastric bypass surgery?
ursodeoxycholic acid
55
Is Peritoneal irritation somatic or visceral
it is somatic – it is sharp
56
SAAG - what can it differentiate between
Serum – ascites. If >1.1 suggests portal HTN (liver or not) aka INC hydrostatic pressure If less than 1.1 suggests TB, Malignancy, Pancreatitis, Nephrotic disease
57
SBP – tx alogithm
– broad abx (cef) – DO NOT DO LVP even if they have a lto of fluid onboard!
58
Pancreatic CA – symptomatic bili and itching - what to do
Tx – palliative – endoscopic Common bile duct stent
59
Esophageal spasm tx?
CCB
60
Dyspshagia in HIV CD4
Empirically start fluconazole over endoscopy or biopsy.
61
HNPCC - when to screen?
25 w.o colo every 1-2 years.
62
PPx in variceal bleeding and ascites?
W variceal bleeding and ascites - need SBP ppx - TMP SMP. After one episdoe fSBP - need lifelong ppx.
63
Autoimmune hepatitis ab?
Anti smooth muscle antibody.
64
If blood diarrhea – EHEC suspected, tx?
DO NO T GIVE ABX – INC RISK OF HUS!
65
Acute cholangitis t x
supportive care and broad abx. If they do not respond, biliary drainage w/ ERCp
66
gastric ulcer - what to do?
Biopsy must be performed on ALL gastric ulcers.
67
Staging of Gatsric Adeno after biopsy?
ct abd pelvis
68
Pathophys – Esophageal varices vs malloryWeiss
Varices- submucosal veins. Mallory Weiss – Submucosal ARTERIES
69
Pleural effusion after thoracentesis in cirrhotic/ascetic pt – tx?
TIPS. Would reappear with chest tube and paracentesis is inadequate.
70
Gallstones, opaque or radiolucent
Cholesterol and mixed stones are RADIOLUCENT – not visible on abdominal xray. Dotn confuse with kidney stones! This is why US and CT are used instead.
71
Appendicitis
– Preop-Abx, NPO, lap appy (if classic, doesn’t require imaging as it may lead to perf; if nontypical, then CT or US). No post op Abx unless rupture
72
INC Alk phosph
next step/? RUQ – assess intrahepatic or extrahepatic bili obstruction
73
Achalasia vs Esophageal stricture
Ach: both soldis and liq. Stricture: Solid dysphagia. gerd complication, may actually improve gerd .
74
Diarrhea vs vomiting metabolic findings
Diarrhea actually losses Bicarb leading to nongap ACIDOSIS. Vomiting alkalosis (saline responsive)
75
Free air w/ history tx algorithim?
Urgent surgery consult. Emergent x lap. After CXR showing free air , no other imaging needed.
76
Celiac disease can cause what heme issue with neg stool occult ?
Iron deficiency anemia due to malabsorption!
77
When to use pancreatic protease inhibitors in pancreatitis?
Don’t use.
78
Which pneumococcal immune is 40 y.o with liver failure?
PCV 23 – 13 is only for ICH/HIV, splenectomy, SS
79
Where does D xylose get absorbed?
Proximal small intestine (NOT TERMINAL ILEUM)
80
Can you treat Chronic Hep C? If considered for tx usu undergo
Yes, tx chronic hep c. undergo LIVER BIOPSY, best clinical predictor and assesses likelihood of response to tx. Those who have more cirrhosis/fibrosis usually respond better to tx.
81
Manometry, achalasia vs systemic sclerosis
Achalasia INC tone, failure to relax. SS fibrosis and atrophy leads to hypomotility and incompetence of LES>
82
Cholangitis workup
– medical emergency (Abx etc) with ERCP decompression. Not surgery.
83
Acute diverticulutlits imaging?
DO NOT COLONOSCOPY, inc risk of perf. CT
84
Pancreatic pseudocyst management
if painless DO NOT DRAIN, painful and greater than 6cm at 6wk, endoscopic drainiage.
85
Pre-appy abx
Cipro and metronidazole ; amp/sulbactam; levofloxacin clinda. Cefotetan.
86
Mesenteric ischemia w/ pain out of proportion to exam algorithm
surgery (embolectomy) or angio (thrombolyisi/vasodilators)
87
Acute ascending cholangitis algorithm –
– IV abx ,emergent decompression of common duct w/ ERCP. Eventual cholecystectomy.

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