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Flashcards in GI Deck (139):
1

Celiac classic

Diarrhea
Weight loss
Anemia (iron deficiency)
Bloating
+/- steatorrhea
Dermatitis herpitiformis

2

Most severely inflamed area in celiac? The result?

Proximal bowel
Results > iron , Ca, folate deficiency

3

Primary sclerosing cholangitis classic?

RUQ pain
Jaundice
Pruritus
High ALP
High bilirubin
+ve p-ANCA
Hx UC

4

Most common hepatic disease in UC?

Primary sclerosing cholangitis

5

Dx sclerosing cholangitis?

MRCP

6

ERCP vs MRCP?

ERCP has higher rate of complications.

7

Safest OTC laxative?

Senna

8

SE of phenolphthalein + Castro oil?

Malabsorption
Dehydration
Lipoid pneumonia
Cathartic colon

9

SE of bisacodyl?

Suppository = rectal burning


Oral = low K, camps, vomiting

10

SE of milk of magnesia

High Mg
Dehydration
Watery stool
Fecal incontinence

11

What's psyllium

Fiber
Bulk-forming laxative.

12

How do you assess cure of H. Pylori?

Urea breath test
Endoscopic biopsy

13

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

Antibodies level

Remain +ve 6-12 months after Rx

14

Gastric outlet obstruction classic?

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

15

Complication of prolonged vomiting?

HypoCl
HypoK
Metabolic alkalosis

16

Radiation proctitis classic

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

17

Indications of TPN?

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

18

Extra intestinal Sx of IBD?

1. MSK
Arthralgia
Ankylosing spondylitis

2. Derm:
Erythema nodusom, pyoderma ganagrenosum, aphthus ulcers.

3. Hepatic
Primary sclerosing cholangitis
Autoimmune hepatitis
Fatty liver
Fall stones

4. Ocular:
Uveitis, iritis, episcleritis
Corneal ulcer
Retinal vascular

5. Renal
Ca oxylate stones

19

What explains the risk of fistulae in Crohn's

Transmural inflammation

20

Rx of choice in fistulizing crohn's?

Anti-TNF (1st line)
AZA, 6-MP (2nd line)

21

Indication of oral steroids in IBD?

Suppress acute flares

22

Rx of acute diverticulitis

Bed rest
IVF
NPO
IV Abx

23

Dx acute diverticulitis

CT

24

Rx of gastroparesis

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

2nd > erythromycin

3rd > cisapride

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