GI Flashcards
(226 cards)
1
Q
What is the MELD score used for?
A
- -prognosis (3 mo. day mortality)
- -prioritization of liver transplant
2
Q
liver enzymes:
4-30 fold ↑↑ in total and direct bilirubin
A
hyperbilirubinemia of sepsis
3
Q
3 tx options for eosinophilic esophagitis:
A
- -PPI
- -topical steroids
- -elimination diet
4
Q
occult GI bleeding often results in:
A
anemia
5
Q
How does the pain threshold of IBS patients compare to controls?
A
IBS patients show lower pain thresholds aka visceral hypersensitivity
6
Q
H. pylori + NSAIDS = ___-fold ↑ in PUD risk
A
60
7
Q
accounts for ≥ 80% cases of UGI bleeds in cirrhotics
A
variceal hemorrhage
8
Q
3 dx methods for gastroparesis:
A
- -succussion splash (done w/ stethescope)
- -UGI (showing dilated stomach)
- -Scintigraphy (rate of gastric emptying)
9
Q
invisible colon on imaging=
A
small bowel obstruction
10
Q
“alarm sssx” in pt. presenting w/ GI ssx should prompt:
A
referral to gastroenterologist
11
Q
2 mechanisms of altered brain-gut communication resulting in FGIDs
A
- -disturbed gut function/ sensation
- -disturbed CNS function
12
Q
Neurotransmitter that affects GI motility, secretion and visceral sensation
A
serotonin
13
Q
Age and gender epidemiology of IBS:
A
60-75% are women and present at a younger age (26-45 yo) More common in Western world (aka caucasians)
14
Q
What determines the character of externalized blood from an upper GI bleed?
A
rate of blood loss
15
Q
What do esophageal varies result from?
A
portal HTN → backup of L. gastric v. →distal esophageal v. → dilation of v. = varice
16
Q
What does the serum ascites-albumin gradient (SAAG) tell you abou the ascites?
A
Whether it is d/t portal HTN or not →
- SAAG ≥ 1.1 = portal HTN
17
Q
DDx of hyperbilirubinemia w/o cholestasis (3):
A
- -hyperbilirubinemia of sepsis
- -Gilbert’s syndrome
- -Hemolysis
18
Q
Medical management of encephalopathy (3):
A
- -ID and correction of precipitating causes
- -lactulose (oral/enema)
- -Rifaximin (non-absorbed Abx) (no role for protein restriction)
19
Q
4 possible pathophysiologic etiologies of GERD:
A
- -incompetent antireflux barrier
- -aggressive refluxate (gastric acid +/- bile acids)
- -↓ clearance of acid from the esophagus
- -↑ abdominal pressure (pregnancy)
20
Q
Diagnostic evaluation for GERD following acid-suppressing Rx trial is indicated for (3):
A
- -doubt about dx (atypical ssx)
- -chronic or refractory ssx
- -“warning ssx” (dysphagia, bleeding, weight loss)
21
Q
What is the parietal peritoneum?
A
thin serous membrane that lines the abdominal cavity
22
Q
2 main etiologies of odynophagia:
A
(painful swallowing)
- -infectious esophagitis (in immunocompromised pts)
- -pill esophagitis (pill gets stuck and dissolves causing direct damage to mucosa)
23
Q
Components of the brain-gut axis (3):
A
- -CNS: brainstem, cerebral cortex
- -ANS: symp. + parasymp.
- -ENS: sensory and motor neurons w/in the gut wall
24
Q
4 food groups removed (FODMAP diet) in diet modulation therapy sometimes used in IBS patients:
A
- -oligosaccharides (fructans & galacto-oligos)
- -disaccharides (lactose)
- -monosaccharides (fructose)
- -polyols (sorbitol, mannitol etc.)
25
5 pathophysiologic causes of chronic diarrhea:
1. osmotic
2. secretory
3. maldigestive/absorptive
4. inflammatory
5. functional
26
Location of ssx of esophageal dysphagia:
suprasternal notch or substernally (rarely epigastric)
27
What are tagged RBC ("bleeding") scans helpful for evaluating?
intermittent bleeding (esp if obscure bleed)
28
Define organic disease:
structure change to tissue or organ
29
define melena:
black, tarry (sticky) stool
30
Other than bleeding, what other possible complications can Meckel's cause (2)?
- obstruction (intussusception or volvulus)
- diverticulitis
31
What are 2 distinct types of GI bleeding that are difficult to detect for the naked eye?
- occult (not visible to patient or physician)
- obscure (overt or occult bleeding that persists or recurs after initial (-) endo/colon-oscopy eval
32
3 signs of liver decompensation:
- ascites
- variceal bleeding
- hepatic encephalopathy
33
Why are Hgb/hematocrit levels not useful in an acute GI bleed scenario?
Hgb/hematocrit isn't ↓ in acute blood loss because the extracellular fluid hasn't had time to move into the vascular dept. yet (to restore circulating volume)
34
orthostatic drop in BP indicates a loss of ~ \_\_% blood volume loss. Is this significant?
15%, YES! -helps you estimate the rate/rapidity of bleeding during eval
35
What test is used to test esophageal motility?
esophageal manometry
36
4 types of mechanical obstructions that can cause esophageal dysphagia:
- tumors (cancer in esophagus/proximal stomach)
- benign stricture
- webs, rings
- foreign body
37
3 dx tests for esophageal dysphagia:
- upper endoscopy
- barium radiography
- esophageal manometry
38
3 factors to consider when deciding whether to order an imaging exam:
- Who is your patient?
- What is their hx?
- Contraindications
39
Diagnostic criteria for spontaneous bacterial peritonitis (SBP):
≥ 250 PMNs/mm^3 in ascitic fluid
40
Is coagulopathy (low platelets) CI to paracentesis?
NO!! No additional risk!! TAP DAT!
41
DDx of cholestatic injury pattern (↑ ALP ± ↑bili) (5):
- 1º biliary cholangitis (PBC)
- 1º sclerosing cholangitis (PSC)
- DILI
- Biliary obstruction
- Infiltrative processes (TB, amyloidosis, lymphoma, diffuse metastatic dz)
42
syndrome (rare) assoc. w/ gastrinomas → PUD
Zollinger-Ellison syndrome
43
What is the definition of IBS in terms of ssx criteria? When is IBS considered chronic?
Recurrent abdominal pain or discomfort ≥ 3 d/mo in the last 3 mo w/ ≥ 2 of the following:
- improvement w/ defecation
- onset assoc. w/ Δstool freq.
- onset assoc. w/ Δstool form
Considered chronic if above is true and ssx onset ≥ 6 mo prior to dx
44
What is required for the brain-gut axis to work properly (2)?
- normally functioning nervous system
- intact smooth muscle
45
4 types of lifestyle modifications used in tx of GERD
- head of bed elevation
- dietary modifications
- weight reduction
- avoidance of late meals
46
What is the ligament of Treitz? What other anatomic landmark coincides w/ its location?
- suspensory muscle of the duodenum
- located @ the duodenal-jejunal junction
47
2 mechanisms by which GERD can cause dysphagia
1. inflammation can cause dymotility
2. stricture
48
2 MCCs of acute diarrhea:
- infx (90%)
- meds
49
T/F: localization of actual GI bleeding site using Tagged RBC scan is easy
False! tricky!
50
What are 4 types of overt (obvious) GI bleeds?
- hematemesis
- coffee ground emesis
- melena
- hematochezia
51
2 uses of angiography in GI bleed:
- identify bleed (0.5-1.0 ml/min)
- treat (embolize) bleed
52
T/F: Fold increase of aminotransferases correlates w/ severity of liver injury
FALSE! Correlates poorly
53
Ambulatory pH monitoring in GERD is indicated for (2):
- atypical ssx and (-) endoscopy
- ssx refractory to standard Rx
54
What are 5 possible etiologies of a LGI small bowel bleed?
- angioectasias (AVM) (more common in old peeps)
- IBD (erosions, ulcers)
- NSAID enteropathy (")
- tumors
- Meckel's diverticulum (more common in kiddos)
55
Define Functional Disorders:
conditions in which the patient has a variable combination of ssx w/o any readily identifiable structural or biochemical abnormality
56
Define hematemesis:
vomit containing obvious blood
57
Which labs should be ordered on ascitic fluid for first time tap in pt. w/ new-onset ascities d/t suspected cirrhosis (2)?
- serum ascites-albumin gradient
- cell count w/ differential
58
occult bleeding is typical of what disease process?
early colon cancers
59
Onset of ssx of oropharyngeal dysphagia
immediate
60
Is H. pylori invasive?
NO!! lives in gastric mucus layer (surface of gastric epithelium)
61
Where is the location of ssx of oropharyngeal dysphagia?
throat above the suprasternal notch
62
How does Zollinger-Ellison syndrome cause PUD?
gastrinoma produces gastrin →↑ blood [gastrin] → gastric acid hyperprdn. →↑ basal acid output → ulcer
63
What are the 4 key general steps to think about when you suspect a patient has a GI bleed?
-confirm there is/has been a GI bleed
* fecal occult blood test etc.
* BUT don't look for anemia (Hbg/hematocrit levels not accurate in acute setting)
- estimate rate/rapidity of bleeding
- resuscitate/stabilize!
- investigate probable site/source of bleeding
64
What does Meckel's diverticulum result from embryologically?
failure of the omphalomesenteric duct to undergo involution during development
65
Rx therapy for H. pylori infx
Triple therapy → PPI + 2 Abx for 2 weeks
66
Which cells in the gut produce and secrete serotonin (5-HT)?
enterochromaffin (EC) cells
67
Define achalasia:
failure to relax (the LES)
68
Common ssx of oropharyngeal dysphagia (5):
\*\*difficulty initiating swallowing +
-cough, choking, drooling, nasal regurgitation
69
As little as 50-100 mL of blood in the upper GI tract can cause \_\_\_
melena
70
Does absence of reflux esophagitis on endoscopy exclude the dx of GERD?
No!! GERD can manifest soley as ssx!! → then titled NERD
71
3 complications of GERD
- ulcer
- stricture
- Barrett's esophagus
72
Evidence supports urgent endoscopy for ***_UGI/LGI_*** bleed
UGI → ↓ mortality, hospital stay, transfusion requirements
73
PE findings suspicious for organic GI dz (4):
- malnutrition
- skin rashes
- inflammatory arthropathy
- abdominal mass
74
supine hypotension occurs w/ loss of ≥ \_\_\_% blood volume?
40%
75
2 GI protective Rxs sometimes used to prevent/ manage NSAID-induced ulcers
- PPIs (no acid → less injury)
- Misoprostol (PG E1 analog)
76
Define dysphagia:
difficulty swallowing
77
Which labs should be ordered on ascitic fluid on subsequent taps in hospitalized pt. or pts w/ suspected infx (2)?
- cell count w/ ddx
- ascitic fluid culture (do in blood culture tubes @ bedside d/t low bacterial load)
78
Reasons to tap ascites (4):
- new onset ascites (confirm etiology)
- R/O infx if ssx present (fever, abd. pain, leukocytosis)
- any evidence of clinical deterioration (all pts. w/ decompensated cirrhosis)
- relief of ssx d/t tense ascites
79
% of total body 5-HT located in the GI tract
95%
80
Goals of IBS therapy (2):
- global relief of ssx (pt. well-being)
- individual ssx relief (abd. pain/discomfort, bloating, altered bowel habits)
81
Are small bowel bleeds below the duodenal-jejunal junction common?
No! Only 5% of GI bleeds caused by lesions b/w the lgmt of Treitz and the ileocecal valve
82
Common ssx assoc. w/ eosinophilic esophagitis (2):
- dysphagia
- food impaction
83
EC cells in the gut produce and secrete 5-HT into the intestinal wall in response to:
stimulation of the villi in the lumen of the intestine
84
Key to maintaining reasonable life exptectancy in patient w/ HCV cirrhosis
prevent any decompensation events
85
4 causes of elevated blood [gastrin]
- PPI use
- atrophic gastritis
- renal failure
- Zollinger-Ellison syndrome (gastrinoma)
86
Tx of acute variceal GI bleed
IV octreotide
87
What are the 3 causes of esophageal dysphagia?
- esophagitis (MC = peptic)
- Mechanical obstruction
- motility disorder
88
What mucosal changes take place in Barrett's esophagus?
squamous epithelium in the distal esophagus is replaced by non-ciliated columnar epithelium w/ goblet cells as a response to acidic stress
89
define coffee ground emesis
vomit containing dark, altered blood
90
liver enzymes: 4-60 fold ↑ ALP only
hepatic infiltration
91
painLESS hematemesis
esophageal varices
92
Imaging exams are most effective at answering ***_specific/general_*** questions
specific
93
Elevations in alkaline phosphatase ± ↑ bilirubin liver enzymes represents:
cholestasis
94
CT of abdomen/pelvis (colon):
- luminal narrowing
- mucosal thickening & hyperenhancement
- segmental involvement
Crohn's dz
95
Red flags on imaging in patients suspected of acute abdomen (3):
- free air
- pneumatosis
- portal venous gas
96
When is surgery indicated for a GI bleed?
reserved for failure of non-surgical Rx (e.g. ulcer bleeding)
97
Research suggests that IBS is caused by:
changes in the nn. and mm. that control sensation and motility of the bowel
98
Is serology for H. pylor infx a useful test to confirm successful tx?
NO! remains (+) for a variable period (yrs) after eradication
99
What occurs during an aortic aneurysm repair that can result in a 2º aortoenteric fistula?
perigraft infection
100
What is the pathogenesis of LGI acquired (false) diverticula?
protrusion of mucosa and submucosa through "weak spots" in circular mm. (where vasa recta penetrate → inner layers)
101
Long term medical management of patient w/ ascites (3):
\*\* Na+ restricted diet (2g/d) !!\*\*
- diuretics (not IV)
- avoid NSAIDs (in pts w/ cirrhosis)
102
2 malignancies assoc. w/ H. pylori:
- Gastric adenocarcinoma
- MALT lymphoma
103
What type of esophageal cancer can Barrett's esophagus turn into?
adenocarcinoma
104
What does the enteric nervous system (ENS) control?
motor, secretory and microcirculatroy activity w/in the GI tract
105
ALT ***_\> / \<_*** AST in most kinds of chronic liver dz
ALT \> AST usually
106
3 things to ask about in hx in diagnostic approach of a functional bowel disorder
1. GI complaints (full GI ROS)
* -n/v
* -abd. discomfort or pain (location, freq., onset, duration, radiation, course)
* -stool freq. and consistency
2. Severity/effects (staging) and chronicity of complaints
3. Psychosocial stressors
107
MCC of oropharyngeal dysphagia
Neuromuscular disorders:
stroke, Parkinson's, bulbar paralysis, MG, neuropathies, myopathies, botulism
108
Define Functional Bowel Disorders:
Ssx relating to the middle and lower portions of the GI tract (abd. pain, bloating, stool irregularity, diarrhea, constipation)
109
4 risks of angiography used to identify and tx GI bleeds
- contrast allergy
- contrast-induced AKI
- bleeding from puncture site
- bowel ischemia
110
3 dx tests for oropharyngeal dysphagia:
- videofluoroscopy
- barium radiography
- nasopharyngeal laryngoscopy
111
What can cause H. pylori dx tests to be falsely negative? Which test is the exception?
Ongoing or recent Abx or PPI use
-exception is serology
112
4 etiologies of PUD:
- H. pylori infx
- NSAIDs
- Hypersecretory states (gastrinoma/ Z-E syndrome)
- Severe physiological stress (Cushing's/Curling's ulcers)
113
common ssx in head and neck cancers
dysphagia (from tumor AND therapy)
114
ALT/AST is more specific for the liver
ALT
115
How do NSAIDs cause ulcers?
inhibit Cox-1 → ↓local PG prdn. → ↓PGs to protect intestinal mucosa
116
Give 3 examples of GI organic diseases:
- PUD
- Celiac
- Pancreatitis
117
5 physical findings in chronic liver dz/cirrhosis:
- Terry's (white) nails
- Palmar erythema
- spider angiomata
- Dupuytren's contracture
- gynecomastia
118
What is the MOST important component of the placebo effect in tx of IBS?
physician-patient relationship (incl. patient education)
119
What enzyme does all strains of H. pylori produce that serves as the basis for several dx tests?
urease
120
3 tx options for achalasia:
- pneumatic balloon dilation
- surgical myotomy
- endoscopic injection of botox
121
What is a "Herald bleed" and why is it a problem?
- self-limited UGI bleed d/t aortoenteric fistula
- presages exsanguinating hemorrhage if the AEF isn't identified in timely fashion
122
MC etiology of achalasia
idiopathic
123
watery diarrhea NOT resolved w/ fasting
secretory (chronic)
124
Which tests confirm liver origin of ↑ alkaline phosphatase in the setting of normal bilirubin levels
5'nucleotidase
125
long term tx option for varices
endoscopic hemostasis
126
CagA-expressing strains of H. pylori are more frequently associated with ***_gastric/duodenal_*** ulcers
duodenal
127
Concerning ('red flag') ssx that require further eval (may indicate organic dz) in patient being assessed for a functional bowel disorder (5):
- weight loss
- hematochezia, melena
- nocturnal ssx
- family hx of IBD or CRC
- age of onset \> 50 yo
128
When are prophylactic Abx given during tx for SBP?
given to cirrhotics admitted w/ GI bleeding
129
How do you treat Meckel's diverticulum?
resection
130
How is hepatic encephalopathy diagnosed?
clinically→ based on presence of signs of advanced liver dz, asterixis ('flapping tremor), and hyperreflexia
131
intermittent dysphagia ssx are indicative of what pathology?
Schatzki's ring
132
Are liquids or solids typically more problematic for patients w/ esophageal dysphagia?
- If d/t mechanical obstruction→ worst w/ solids
- If d/t motility disorder → ssx same w/ liquids and solids
133
Anatomically, where is an upper GI bleed located (aka what's the cut off structure)?
bleed from a source proximal to the ligament of Treitz
134
Elevations in aminotransferases (ALT, AST) indicate:
hepatocellular injury
135
Define hematochezia
stools containing obvious bright red blood
136
Why does bleeding occur w/ Meckel's?
d/t ulceration w/in the diverticulum or from adjacent mucosa (d/t ectopic acid prdn.)
137
T/F: elevated blood ammonia levels are necessary for a dx of hepatic encephalopathy
FALSE!! Not required and do not need to be followed!!
138
4 common causes of gastroparesis
- Diabetic gastropathy
- nerve damage
- post-viral gastroenteritis
- scleroderma
139
Labs indicative of Iron Deficiency (assumed d/t occult blood loss until proven otherwise)
* serum iron: ↓ (1º)
* transferrin/TIBC: ↑ (compensatory)
* ferritin: ↓
* % transferrin saturation: ↓↓
140
Common ssx for GI malignancies (6):
What determines ssx?
location determines ssx→
* -dysphagia
* -pain
* -anemia
* -vomiting, diarrhea, obstruction
* -weight loss
* -jaundice
141
When is the LES triggered to relax?
in response to the initiation of swallowing
142
If you use additional info. (hx, PE, labs) to refine your question prior to ordering an imaging exam, you ↑ your chances that(3):
* -you will order the right exam
* -the exam will be performed in the correct way
* your patient will not be harmed
143
Where, anatomically, does Meckel's diverticulum occur?
distal ileum
144
Blood clots in the stool favors ***_UGI/LGI_*** source
LGI
145
What are the 4 causes of oropharyngeal dysphagia?
1. -poor dentition (teeth arrangement)
2. -↓ saliva production (d/t Sjorgren's or meds)
3. -NM disorders
4. -Structural lesions (tumor, zenker diverticulum, local inflammation)
146
Rx and timing of Rx for SBP (2):
- broad-spectrum Abx (if culture is (-))→ e.g. Cefotaxime; IV 5-7 days
- IV albumin on day 3 to help prevent renal dysfunction
147
Additional psychological therapy (to patient education) that improves IBS ssx
cognitive behavioral therapy
148
Is there any risk of PUD using Cox-2 selective NSAIDs?
YES! lower than for Cox-1 drugs but not 0!
149
What is the definition of GERD?
frequent ssx or complications caused by gastroesophageal reflux
150
How is occult GI bleeding manifested (2)?
* iron deficiency→ chronically can cause anemia
* (+) fecal occult blood test
151
3 tx options for gastroparesis
* -improve underlying condition
* -promotility agents (partially useful)
* -placement of PEG/PEJ tubes
152
Why can pregnancy cause GERD?
↑ abdominal pressure
153
liver enzymes: all (AST, ALT, ALP, Tbili, Dbili, LDH) mildly elevated
chronic hepatitis
154
hyperbilirubinemia w/o cholestasis in outpatient setting w/ ↑ unconjugated (indirect) bilirubin
Gilbert's syndrome
155
pancolonic wall thickening on abdominal/ pelvic CT
pseudomembranous colitis
156
3 MC functional bowel disorders:
* -IBS
* -functional constipation
* -functional dyspepsia
157
Hx: previous aortic aneurysm repair
CT: ectopic gas, focal bowel wall thickening, breach of aortic wall, extravasation of contrast into bowel lumen
2º aortoenteric fistular (UGI bleed)
158
2 types of motility disorders that can cause esophageal dysphagia:
* -achalasia
* -scleroderma
159
What kind of anatomical anomaly can cause GERD via an incompetent anti-reflux barrier?
hiatal hernia
160
neuroendocrine induced diarrhea
secretory (chronic)
161
hyperbilirubinemia w/o cholestasis in hospitalized pt. w/ ↑↑ Dbili and minimal ↑ in ALP, ALT, and AST
hyperbilirubinemia of sepsis
162
Why can achalasia cause pulmonary problems?
d/t chronic aspiration
163
DDx of "mild" hepatocellular injury (ALT/AST ≤ 20x ULN, usually much less) (5)
1. -chronic viral hepatitis
2. -NAFLD
3. -AI hepatitis
4. -drug-induced liver injury (DILI)
5. -congestive hepatopathy
(wilson's dz) (α-1 anti-trypsin def.)
164
Is the presence of odynophagia in GERD common? What can it's presence indicate?
NO! → may indicated an ulcer
165
What is responsible for the dark color of melena?
action of gut bacteria
166
Procedure of choice in hemodynamically unstable patient experiencing GI bleed
angiography
167
Define Functional Gastrointestinal Disorders (FGID):
Broad term that encompasses a number of separate idiopathic disorders which affect different parts of the GI tract (+ biliary); any portion of GI tract can be affected
168
hyperbilirubinemia w/o cholestasis in outpatient setting w/ ↑ unconjugated (indirect) bilirubin, ↑LDH, ↓haptoglobin
hemolysis
169
Onset of ssx of esophageal dysphagia:
after several seconds
170
Onset of ssx of achalasia:
SLOWLY progressive
171
4 dx tests of H. pylori infx:
* -urease breath test
* -stool antigen test
* -serology (IgG anti-Hp Ab)
* -gastric bx (if EGD performed)
172
If the patient is experiencing a massive GI bleed, should you do an endoscopy?
No! consider alternatives → angiography
173
5 extraesophageal ssx in GERD
* -hoarsness (d/t reflux laryngitis)
* -globus sensation ('lump in throat')
* -chronic cough
* -asthma (d/t intermittent microaspiration)
* -chest pain
174
Angiography and Tagged RBC scans both require active bleeding but which one is more sensitive?
Tagged RBC scan (0.1 - 0.5 ml/min)
(vs. 0.5-1.0 ml/min for angiography)
175
Identification of GI bleeding site w/ angiography requires active bleeding of at lease ____ ml/min
0.5-1.0 ml/min
176
Common pertinent hx findings in IBS patients (2):
- anxiety and/or depression
- abuse (30-56%)
177
duration of acute diarrhea:
\< 2 weeks
178
What is the MELD score used for?
- prognosis (3 mo. mortality)
- prioritize patients for liver transplant
179
What is eosinophilic esophagitis?
infiltration of eosinophils in the esophagus in atopic patients (usually d/t food allergy)
180
Are liquids or solids typically more problematic for patients w/ oropharyngeal dysphagia?
liquids
181
Ssx include:
- postprandial bloating, early satiety
- delayed vomiting partially digested contents
- refractory GE reflux
gastroparesis
182
Lab values used to calculate MELD score (3):
* -creatinine
* -INR
* -bilirubin
183
What are some causes of LGI bleeds (6)?
Which ones are more likely to cause massive bleeding?
Causes of massive bleeds:
* diverticula (acquired, false)
* ischemia
* AVMs
Less likely to cause massive hemorrhage:
* IBD
* Colon cancer
* hemorrhoids
184
What are 3 subtypes of IBS?
1. -IBS-D(iarrhea)
2. -IBS-C(onstipation)
3. -IBS-M(both)
185
Does eradication of H. pylori ↓ ulcer recurrence?
YA! ~90% → 10%
186
H. pylori strains w/ CagA + VacA are associated w/ what?
greater tissue inflammation and cytokine production
187
stomach pain ↓↓ by food or antacids
PUD (duodenal)
188
Is Meckel's diverticulum a true or false one?
true! contains heterotopic mucosa (usually gastric)
189
Which part of the bowel is often the source of obscure GI bleeding?
small bowel→ often unreachable from upper and lower endoscopy
190
2 useful uses of US during pt. eval of pancreatitis:
- looking for stones as the cause during 1st episode
- following pseudocysts
191
5 things you should look for on an abdominal x-ray in patients suspected of acute abdomen:
1. -bowel gas pattern
2. -pneumoperitoneum/ free air
3. -calcifications
4. -tubes and lines
5. -lung bases
192
2 pathologic conditions that result in 10-100 fold ↑↑ in AST and ALT enzymes
- acute hepatitis (drug, viral)
- ischemic hepatitis
193
What are some factors (2) limiting the usefulness of urgent colonoscopy in LGI bleeding?
- bowel prep needed before lower scope
- difficulties identifying bleeding site → limits ability to intervene
194
Which tests confirm liver origin of ↑ alkaline phosphatase in the setting of additional ↑ bilirubin
↑GGT
195
DDx of "extreme" hepatocellular injury (ALT/AST ≥ 30x ULN) (4):
1. -acute viral hepatitis
2. -hepatic ischemia ("shock liver")
3. -DILI (acetaminophen)
4. -toxin (mushrooms)
196
Define odynophagia
pain w/ swallowing
197
What does ↓ ferritin lab values indicate?
depletion of stored iron
198
3 questions to ask patient about the character of their dyspepsia:
1. -pain (sharp/dull, burn, cramp, hunger)
2. -n/v
3. -fullness (bloating, early satiety)
199
4 common esophageal ssx of GERD
- heartburn (pyrosis)
- regurgitation
- water brash
- dysphagia
200
What are the 2 types of Aortoenteric fistulas? Which one is more common?
1º and 2º(MC)→ usually occurs following repair of aortic aneurysm
201
3 tests to dx achalasia:
* -barium study
* -manometry
* -upper endoscopy (EGD)
202
MCC of UGI bleeding
peptic ulcer (usually duodenal)
203
Medical Management of variceal bleed (3):
1. -Hemodynamic resuscitation (large-bore IV + blood prdts)
2. -begin octreotide drip
3. -Abx prophylaxis
(call GI and consider intubation)
204
MC infx world-wide
H. pylori
205
Duration of chronic diarrhea
\> 4 weeks
206
Which lab value (other than AST/ALT) is extremely increased (10-90 fold) in ischemic hepatitis vs. acute hepatitis?
LDH
207
Define pyrosis:
retrosternal burning ("heartburn")
208
How does H. pylori inhabit and disrupt the gut wall?
NOT INVASIVE -lives in gastric mucus layer (surface of gastric epithelium) → disrupts mucus layer→ makes it vulnerable to acid and bacterial enzymes and toxins
209
massive bleeding from an UGI source can cause:
hematochezia → patients will be hemodynamically unstable
210
Ultimate result of 5-HT induced NT cascade in the gut
proximal gut contraction and distal relaxation + secretion
211
Is acetaminophen a NSAID?
NO!!
212
2 important IBS dz modifiers that interact w/ both early life factors and concurrent modifying factors in the genesis of CNS-ENS dysregulation
* -chronic life stress
* -enteric infx/inflammation
213
"alarm sssx" in pt. presenting w/ GI ssx (7) → indicate potential serious dz
* -early satiety
* -dysphagia
* -hematemesis
* -anemia
* -occult blood in stool
* -melena
* -onset \> 45 yo
214
Define dyspepsia
"disturbed digestion" encompasses multiple UGI ssx (pain, discomfort, bloating, fullness, nausea, belching, etc.)
215
watery diarrhea resolved w/ fasting
osmotic (chronic)
216
liver enzymes:
1-100 fold ↑↑ in ALP, Tbili, and Dbili
cholestasis
217
What type of surgery is sometimes used in tx of GERD?
fundoplication
218
What are the 3 physiologic phases of swallowing? What do they each require for proper function?
1. oral preparatory phase→ requires chewing, salivation, NM coordination
2. Pharyngeal phase→ requires NM coordination, unobstructed lumen, relaxation of UES
3. Esophageal phase→ requires esophageal peristalsis, unobstructed lumen, relaxation of LES
219
Does the presence of melena indicate the presence of an active bleed?
Not necessarily! Melena may persist for several days after a bleed
220
Does GI angiography require a bowel prep?
NOPE!
221
Hepatic encephalopathy may be precipitated by (6):
* -bleeding
* -infx
* -dehydration
* -electrolyte abnormalities
* -narcotics
* -benzodiazepines
222
Common pathologic finding upon endoscopy in this dz process = "trachealization"
eosinophilic esophagitis
223
BUN/creatinine ≥ 20 favors ***_UGI/LGI_*** source?
UGI source
224
painful hematemesis
mallory-weiss syndrome
225
liver enzymes:
- mildly elevated aminotransferases w/ AST:ALT ≥ 2:1
- 1-20 fold ↑ in Tbili and Dbili
alcoholic (hepatitis) liver dz
226
Define gastroparesis:
delayed gastric emptying
