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GI Flashcards

1
Q

Celiac classic

A 
Diarrhea 
Weight loss
Anemia (iron deficiency) 
Bloating 
\+/- steatorrhea 
Dermatitis herpitiformis
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2
Q

Most severely inflamed area in celiac? The result?

A

Proximal bowel

Results > iron , Ca, folate deficiency

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3
Q

Primary sclerosing cholangitis classic?

A 
RUQ pain 
Jaundice 
Pruritus 
High ALP
High bilirubin 
\+ve p-ANCA
Hx UC
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4
Q

Most common hepatic disease in UC?

A

Primary sclerosing cholangitis

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5
Q

Dx sclerosing cholangitis?

A

MRCP

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6
Q

ERCP vs MRCP?

A

ERCP has higher rate of complications.

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7
Q

Safest OTC laxative?

A

Senna

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8
Q

SE of phenolphthalein + Castro oil?

A

Malabsorption
Dehydration
Lipoid pneumonia
Cathartic colon

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9
Q

SE of bisacodyl?

A

Suppository = rectal burning

Oral = low K, camps, vomiting

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10
Q

SE of milk of magnesia

A

High Mg
Dehydration
Watery stool
Fecal incontinence

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11
Q

What’s psyllium

A

Fiber

Bulk-forming laxative.

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12
Q

How do you assess cure of H. Pylori?

A

Urea breath test

Endoscopic biopsy

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13
Q

What can’t be used to assess cure of H. Pylori? Why?

A

Antibodies level

Remain +ve 6-12 months after Rx

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14
Q

Gastric outlet obstruction classic?

A 
Nonbilious vomitus
Food particles 
W/in 1 hr of meal 
Epigastric fullness 
Dilated stomach (tympanitic mass)
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15
Q

Complication of prolonged vomiting?

A

HypoCl
HypoK
Metabolic alkalosis

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16
Q

Radiation proctitis classic

A 
Hx of radiation. 
Painful defecation 
Diarrhea 
\+/- rectal bleed 
=> scope: friable mucosa + telangiectasia.
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17
Q

Indications of TPN?

A

Poor functioning GI tract (obstruction, fistula, short bowel)
Can’t tolerate other means

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18
Q

Extra intestinal Sx of IBD?

A
  1. MSK
    Arthralgia
    Ankylosing spondylitis
  2. Derm:
    Erythema nodusom, pyoderma ganagrenosum, aphthus ulcers.
3. Hepatic 
Primary sclerosing cholangitis 
Autoimmune hepatitis 
Fatty liver 
Fall stones
  1. Ocular:
    Uveitis, iritis, episcleritis
    Corneal ulcer
    Retinal vascular
  2. Renal
    Ca oxylate stones
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19
Q

What explains the risk of fistulae in Crohn’s

A

Transmural inflammation

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20
Q

Rx of choice in fistulizing crohn’s?

A

Anti-TNF (1st line)

AZA, 6-MP (2nd line)

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21
Q

Indication of oral steroids in IBD?

A

Suppress acute flares

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22
Q

Rx of acute diverticulitis

A

Bed rest
IVF
NPO
IV Abx

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23
Q

Dx acute diverticulitis

A

CT

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24
Q

Rx of gastroparesis

A

Small frequent meals
Glycemic control
1st > Pro-kinetics (domperidone, metoclopramide)

2nd > erythromycin

3rd > cisapride

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25
What's Gilbert's disease
Indirect hyperbilirubinemia caused by glucuronyl transferase impairment.
26
What investigation is contraindicated during acute flares of UC? Why?
Barium enema | Risk of perforation
27
Non alcoholic fatty liver associations
T2DM | Obesity
28
Complications of nonalcoholic fatty liver
Cryptogenic cirrhosis esp in obese
29
Labs in alcoholic fatty liver
AST/ALT ratio > 2 | Most sensitive + specific
30
Late sign of achalasia?
Dilated esophagus Air fluid level Retained food On CXR
31
Dx of achalasia?
Nanometry
32
What must be r/o in achalasia?
Tumor of gastroesophegeal junction R/o via endoscopy
33
Risk of developing adenocarcinoma from Barrett's?
<1%
34
Dx gastroparesis
Gastric emptying scintigraphy
35
Labs in acute HepB infection
HBsAg | HBcAg IgM
36
Rx of acute HepB?
Not specific Stop alcohol Stop liver offending agents
37
Most common cause of minimal per recall bleed in < 50 yrs
``` Anorectal pathology Hemorrhoids Fistula Polyps Proctitis Ulcers Cancer ```
38
Approach to PR bleed?
< 50 yrs 1. Anoscopy if no cause identified > colonoscopy > 50 Straight colposcopy Higher risk of Ca
39
Organism in spontaneous bacterial peritonitis
E. coli > klebsiella > Strept Single organism
40
WBC in ascetic fluid of spontaneous bacterial peritonitis
WBC > 500 | Neutrophil > 250
41
Acute mesenteric ischemia classic?
Elderly Abdominal pain (out of proportion) +/- AFib
42
Warning signs in IBS?
``` Rectal bleeding Anemia Weight loss Fever FHx CRC Onset > 50 yrs ```
43
Rx of diarrhea in IBS?
Loperamide
44
Market of chronic liver disease? Why?
Low albumin | It's 1/2life 26 days
45
Most commonly involved area in crohns?
Terminal ileum
46
Drug causes dysphagia?
Ant dopaminergic Atypical antipsychotics (resperidone)
47
Ranson's Criteria?
``` < 48 hr: Age > 55 WBC > 16 LDH > 350 AST > 250 Glucose > 10 ``` ``` > 48 hr: Hct >10% drop BUN > 1.79 Ca < 2 O2 < 60 Base deficit > 4 Fluid needs > 6L ```
48
Dx of alcoholic liver disease?
AST:ALT > 2 | AST 2x higher than ALT
49
Pancreatic enzyme in alcoholic pancreatitis?
Amylase is less likely to be elevated. | High lipase:amylase ratio (more specific in alcoholic)
50
Dx gallstones?
US
51
PEG tube risk?
Increases risk of pressure ulcer. Aspiration risk is not reduced. Increase discomfort
52
P450 Inhibitors
``` Ciprofloxacin Fluconazole Clarithromycin Grapefruit CCB ```
53
P450 inducers
Phenytoin St. John's Rifampin
54
Strep bovis association
Colon Ca
55
Sign of secretory diarrhea
Not relieved by fasting
56
Would you Rx asymptomatic call stone?
No
57
Most common cause of acute pancreatitis
Gall stones. | Alcohol
58
Dx acute pancreatitis?
Pain radiated to back Better leaning forward High amylase / lipase
59
Rx acute pancreatitis
IVF Pain control NPO + nutritional support.
60
When to give Abx in acute pancreatitis
Imipenem | Complicated with infected pancreatic necrosis
61
Specific test for acute pancreatitis
Lipase 3x normal level.
62
What effect amylase levels in acute pancreatitis & how?
TG | High TG = low amylase
63
Are amylase level associated with severity of acute pancreatitis
No
64
What dose lactic acidosis + abdominal pain indicate
Intestinal ischemia
65
Rx intestinal ischemia
IVF | Surgical resection
66
Pale stool + dark urine indicates
Obstructive jaundice
67
IMP lab in obstructive jaundice
High ALP
68
Constipation prophylaxis in opioids Rx?
Senna
69
Sx of biliary colic
Episodic epigastric / RUQ non colicky pain Radiates to Rt shoulder At night
70
How to confirm a high ALP is related to liver disease?
Measure 5'-nucleotides
71
What must be r/o in persistently high liver enzymes
Viral Hepatitis
72
Rx of hiccups
1. Physical maneuvers Irrupting breath cycle (breath holding) Valsalva Cotton swab stimulation Vagal maneuver (press eyes + ice bag on forehead) Counteract irritation of diaphragm (knee to chest / lean forward) 2. Drugs: - Chlorpromazine > drowsiness + tardive dyskinesia - Metclopromide > tardive dyskinesia - baclofen not very effective
73
Best initial test for RUQ pain?
US
74
Causative organism of epiglottis
H. Influenzae B
75
Epiglottitis classic
``` Muffled voice Strider (high pitch) Swallow difficulty Drooling Tripod /. Lean forward Tender LN ```
76
Rx of epiglottitis
Supportive | Maintain airway = call ER!
77
Rx of chronic cough + no clear cause
Trial of PPI even if not symptomatic
78
T/F: tolerance to constipation of opioids develops over time.
F
79
1st Rx in constipation in elderly?
- Bowel retraining - Diet fibers - exercise
80
2n Rx in constipation
``` Laxatives Stool softener (not helpful in ill elderly) ```
81
Rx of PUD
PPI 4 weeks | Of not healed = prolong Rx + look for underlying Dz
82
Melanosis coli classic
- blue-brown-black discoloration of colon mucosa. - intense color inside anal sphincter, lighter in sigmoid. - from fecal stasis + use of laxatives
83
Drug induces esophagitis
Tetracycline esp. doxycycline. Others: NSAIDs, KCL, iron, Bisphosphonate, quindine
84
Wilsons disease inheritance
AR
84
Pathophysiology of wilsons.
Excessive copper deposition in liver, CNS
85
Wilsons Rx
D-penicillamine
86
Monitor Rx of Wilsons
Urinary copper excretion | Normal < 40
87
Dx Wilsons
Urinary copper | Serum cerulopasmin
88
Classic Wilsons
Neuro: ataxia, can't speak, spasticity. Eye: kayser-Fischer ring Abnormal LFT
89
Toxic dose of acetaminophen
7.5 g | 150 mg/kg
90
Stages of acetaminophen toxicity
- 1st (24 HR): Asymptomatic Anorexia, N/V Diaphoresis ``` - 2nd (72 HR): RUQ pain NV High HR, low BP. Labs = high BUN, creatinine, LFT + oliguria ``` ``` - 3rd: Jaundice Coagulopathy Encephalopathy Low glucose. ``` - 4th (21 days)
91
Liver transplant indication in acetaminophen toxicity
Creatinine > 300 INR 6.5 PH < 7.3
92
Hints for MEN 1
Persistent PUD High Ca Diarrhea FHx
93
Dx ZOllinger-Ellison
Gastrin level
94
Investigations in dysphagia
Barium swallow
95
Sensitive enzyme for acute pancreatitis?
Lipase
96
What enzyme maybe normal / doesn't correlate to severity of acute pancreatitis
Amylase
97
MCC of PUD?
H. Pylori
98
Weight loss work up
CBC, CMP, occult blood, TSH
99
Drugs cause weight loss
``` SSRI NSAIDs Bupropion Digoxin Metformin ```
100
Drugs cause weight gain
Amitriptyline Mirtazapine Megestrol (serious SE)
101
Antibodies in celiac
IgA anti-endomysial Ab.
102
Rx of 2nd degree hemorrhoids
Band ligation.
103
Drugs not helpful in COPD exacerbation
Inhaled steroids Acetylcystine Mucolytics
104
Gallstone Ileus classic
Abdominal pain N/V AXR: air fluid level + pneumobilia
105
Gallstone ileus pathophysiology
Bowel obstruction from gallstone passed through cholecystodudenal fistula
106
Rigler's triad
In gallstone ileus Pneumobilia Bowel obstruction Gallstones in Rt iliac fossa.
107
Diverticulitis classic
LLQ pain | Normal AXR
108
Oral testosterone SE
Hepatotoxicity including neoplasms
109
Acute diverticulitis Rx
``` Outpatient Clear liquid diet Abx: Cipro or TMP/SMZ + metro Other options: Moxifloxacin Amoxi/Clavu ```
110
Maximum daily dose of acetaminophen?
4000 mg
111
Rx crohn's
1. Sulfasalazine or mesalazine If not enough add Abx: metro > cipro
112
Dx anal fistula
Scope +/- MRI
113
Rx of gastroparesis in Parkinson's? Why?
Domperidone Doesn't cross BBB
114
Metclopromide in Parkinson's
Contra indicated! | It's dopamine antagonist crosses BBB
115
Rx of ascites
Bed rest Na restriction Diuretics Paracentesis
116
AST:ALT in alcoholic vs non alcoholic fatty liver
Alcoholic: >2 Non: <1
117
Rx of shigella diarrhea
1. Fluids +/- fluoroquinolones
118
Primary biliary cirrhosis
``` Steatorrhea Xanthelasma Xanthoma Pruritus High ALP High Bilirubin Anti mitochondrial ab ```
119
What's megestrol
Pro gestational agent | For appetite stimulation
120
SE of megestrol
ACTH suppression + adrenal suppression PE Thrombophlebitis
121
Instruction w/ megestrol
Steroids before surgery
122
Osmotic laxative
Polyethylene glycol
123
Stimulant laxatives
Senna | Mineral oil
124
Bulk forming laxative
Polycarbophil
125
Rx of hemodynamically unstable UGI bleed
IVF | Vasopressin (terlipressin)
126
SE of terlipressin
High PVR Low CO Low coronary blood flow
127
Prevent terlipressin SE
Combine w/ glycerl trinitrate
128
Meds contraindicated in UC? Why?
Narcotic anti diarrheal Risk of toxic mega colon
129
Zenker diverticulum classic
Halitosis Late regurgitation of indigestion food Choking on food
130
Thrombosis hemorrhoids classic
Acute sever perianal pain w/ walking or sitting
131
Rx thrombosed external hemorrhoids
Excision if < 72 HR | Conservative > 72 HR
132
Rx of C. Diff
Metronidazole | If recurs metronidazole (not sever) or oral vanco ( sever / no response)
133
Drug contraindicated in diabetic gastroparesis
Exenatide (GLP-1) | Pramlintide (amylin analogue)
134
Risk group for barrett
Male
135
Normal ALP
35-100
136
Normal ALT
36 U/L
137
Normal AST
35
138
Normal total bilirubin
< 20 umol/L Or < 1.2 mg/dL

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