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GI Flashcards

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1
Q

What are the common causes of esophagitis?

A

CMV and HSV

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2
Q

A pt presents with odynophagia or dysphagia and retrosternal pain and they have HIV – what dx do you think of?

A

Esophagitis

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3
Q

How would we dx esophagitis?

A

endoscopy

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4
Q

A pt presents with a dysphagia and receives a barium swallow that shows a birds beak deformity – dx? Tx?

A

Achalasia, tx = CCB and nitrates (eventually dilation)

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5
Q

If a pt has dysphagia what should be done first to find a cause?

A

endoscopy helps to r/o malignancy

Barium swallow is an okay place to start

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6
Q

If a pt has regurgitation of undigested food along with dysphagia and halitosis – dx? Tx?

A

Zenker diverticulum (out-pouching in the pharynx)

Tx w/ surgery

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7
Q

If dysphagia progresses from solids to liquids – what do you think of?

A

esophageal carcinoma

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8
Q

If a pt has chest pain and dysphagia that will occur even when they don’t eat– dx? Tx?

A 
Diffuse esophageal spaspm AKA Nutcracker
 
Diagnose with manometry
 
Treat with CCB, nitrates, and botox
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9
Q

What disorder occurs in the proximal esophagus and is associated with iron deficiency anemia?

A

Plummer-vinson syndrome

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10
Q

Where does Schatski esophageal ring occur?

A

Distal esophagus

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11
Q

What is the most common type of esophageal cancer?

A

Adenocarcinoma – Associated with Barrett’s

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12
Q

What’s the most common risk factor for esophageal cancer?

A

Smoking and chronic alcohol

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13
Q

What is Budd-chiarii syndrome?

A

Thrombosis of the portal vein leading to esophageal varicies

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14
Q

What’s the most common cause for esophageal varicies?

A

cirrhosis leading to Portal HTN

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15
Q

A pt presents with hematemesis or coffee ground emesis what should you think of?

A

Esophageal varicie

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16
Q

How do we prevent an esophageal bleed?

A

If a pt has cirrhosis Tx with BB’s; Endoscopic band ligation (also for acute bleed)

Abx, shunts, liver transplant, STOP drinking

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17
Q

A pt was vomiting and then started to vomit blood – dx? Tx?

A

Mallory Weiss tear

Tx = generally resolves on it’s own; PPI can help

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18
Q

What’s the most common cause of acute hepatitis?

A

Viral – Hep A and E

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19
Q

What are the phases of sxs for viral hepatitis?

A

Prodoromal = malaise, myalgia, fatigue, N/V/D, abdominal pain

Icterus = jaundice, pruritis, liver tenderness

Convalescent = return to well being

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20
Q

How high would a bilirubin be in hepatitis?

A

Greater than 3.0

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21
Q

How high would AST/ALT be in hepatitis?

A

Greater than 5,000

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22
Q

If AST is greater than ALT what should you think?

A

Alcohol hepatitis

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23
Q

If ALT is greater than AST what should you think?

A

Viral hepatitis

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24
Q

Which two hepatitis are transferred fecal-orally?

A

Hep A and E

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25
Which hepatitis can occur because of shellfish?
Hep A
26
Which Hepatitis can only occur with another form of hepatitis, and which one?
Hep D can only occur in the presence of Hep B
27
Which hepatitis is due to IV drug use, cirrhosis, or blood transfusion?
Hep C
28
If a pt has a positive HbsAg – Dx?
Active Hep B
29
If a pt has a positive Anti-HBs – Dx?
Resolved Hep B infection OR vaccinated
30
What does the presence of an IgG tell us about Hep B?
Chronic infection or Resolved infection (depending if it with the HBsAg or the Anti-HBs)
31
What’s the most common blood-borne infection in the US?
Hep C
32
If AST is greater than ALT by 2:1 what do you think of?
Cirrhosis
33
What type of anemia is seen in cirrhosis?
Megaloblastic
34
How do we treat someone with cirrhosis?
Abstinence from alcohol, vitamin supplementation, nutritional supplementation, immunizations, liver transplant
35
What are the tumor markers for liver cancer?
Alpha fetoprotein and GGTP
36
If a pt has edema form portal HTN what should we treat them with?
Spironolactone
37
How do we Dx and treat diverticulitis?
Cipro and flagyl               Diagnose with a CT
38
Skip lesions and fistulas are present in what disorder?
Crohn’s
39
Mucosal irritation of the colon only is what?
Ulcerative colitis
40
Is ulcerative colitis or chron’s disease where continuous damage would occur?
Ulcerative colitis
41
For both crohn’s and ulcerative colitis – how would we treat an acute exacerbation?
Corticosteroids
42
A pt with diverticulosis should have a diet high in what?
Fiber
43
When does colonscopy screening start?
Age 50
44
If a colonoscopy shows pedunculated, small, or tubular – what does that mean?
Good
45
If a colonscopy shows sessile, no stalk, or villous – what does that mean?             
Bad
46
If a colonscopy has 1-2 benign polyps – when do we repeat?
5 years
47
If a colonscopy show premalignant polyp – when do we repeat?
3 years
48
If a colonscopy shows dysplasia or lots of polys – when do we repeat?
1 year
49
What medications can makes GERD worse?
NSAIDS, Abx, iron, bisphosphonates
50
When do you puruse an endoscopy for GERD?
If age is greater than 50, weight loss, melena, difficult/pain with swallowing, heavy alcohol/tobacco use, and non-responsive to treatments
51
How do we treat GERD first?
Lifestyle modifications - stop smoking, eat several hours before bed, avoid large meals, irritating foods (tomatoes, chocolate, fried foods, caffeine), raise HOB
52
What are the mainstay medications for GERD?
H2 blockers               PPI’s
53
What are the ALARM symptoms for GERD?
Dysphagia, odynophagia, weight loss, and anemia
54
A pt presents with a burning/gnawing pain that radiates to the back – Dx?
Peptic Ulcer Disease               Confirm with H. pylori testing – c-urea and fecal antigen testing
55
How do we treat PUD?            
PPI, clarithromycin, amoxicillin, and metronidazole
56
If a stone is in the cystic duct – dx?
Cholecystitis 
57
if the stone is in the common bile duct – dx?
Choledocolithiasis
58
What are the sxs of acute cholecystitis?           
RUQ/epigastric pain, referred scapula pain, n/v, fever/chills.
59
How do we confirm dx of acute cholecystitis? 
U/S, CBC, LFTs, HIDA
60
If we see fever, jaundice, RUQ pain – think?   
Cholangitis (AKA charcot’s triad)
61
IF we see fever, jaundice, RUQ pain, AMS, and shock – think?
Septic cholangitis (AKA renold’s pentad)
62
How do we dx and tx choledocolithiasis?        
dx = MRI               Tx = ERCP
63
Epigastric pain that radiates to the back indicates what?
Pancreatitis
64
What are the most common causes of acute pancreatitis?
Gallstones and alcohol
65
What are 2 signs associated with pancreatitis?
Cullen’s (periumbilical)               Turner’s (flank ecchymosis)
66
Is amilase or lipase more sensitive?
Lipase
67
What’s the best imaging for pancreatitis?
CT or MRI
68
What are the criteria for admission of acute pancreatitis?
Age older than 55, WBC greater than 16,000, glucose greater than 200, LDH greater than 2x normal, AST greater than 6x normal (high the score = more severe the disease)
69
How do we treat acute pancreatitis?  
NPO and supportive care (IV fluids)
70
How do we treat chronic pancreatitis?
No alcohol, pancreatic enzyme replacement + PPI + low fat diet, insulin
71
CA 19-9 is associated with what?
Pancreas
72
If an elderly pt has maroon colored stools, melena, and fatigue – what dx?
Angiodysphagia (fragile blood vessels of colon)
73
If a pt has dyspepsia, weight loss, anemia, and the presence of GI bleeding – what should you think of?          
Gastric cancer
74
If a pt has painless bright red blood with defecation – dx?
Internal hemorrhoid
75
If a pt has painful bright red blood with defecation – dx?        
External hemorrhoids
76
Which type of hemorrhoids are graded?
Internal
77
How do we treat first or second degree hemorrhoids?            
Fiber, water, stool softner, cortisone
78
How do we treat third or fourth degree hemorrhoids?
Surgical
79
If you see an apple core on an abdominal film – dx?    
Colon cancer
80
How do you treat an anal fissure?      
Bulk agents, stool softner, sitz baths, hydrocortisone
81
A man is unable to sit due to pain, on palpation there is fluctuant mass – dx? Tx?
Anal fistula               Fistulotomy (left open by secondary intention to heal)              *must preserve sphincter muscles!
82
How do we test for celiac disease?
Anti-tissue transglutaminase
83
What form of hepatitis can be transferred from mom to baby?
Hep B
84
Pain is out of proportion to exam – you think of ischemic bowel – what should you ask about the patient’s history?
Afib!!
85
A pt presents with asterixis and AMS.  He jaundiced on exam – dx?  Tx?
Hepatic encephalopathy               Tx with lactulose (to scidify the stools by trapping ammonia)
86
A pt has bloody diarrhea, fever, and cramps.  There are WBC’s in his stool – dx?  Tx?
Salmonella infection               Tx = Usually none, but if immunocompromised give Cipro
87
If pt has diarrhea and ate shellfish -dx?
Vibrio
88
How do we diagnose for giardia?  Tx?
ELISA  Tx with Metronidazole
89
How do we treat c diff?
Metronidazole
90
When should we further evaluate diarrhea?
``` Fever greater than 101.3, bloody diarrhea, abdominal pain               More than 6 loose stools in 24 hours               Frail pts/immunocompromised ```
91
How do we rehydrate pts?
½ tsp salt, 1 tsp baking soda, 8oz OJ diluted with 1L
92
What causes appendicitis?
Fecolith (bacterial overgrowth via e. coli)
93
What do parietal cells do?
Secrete intrinsic factor – necessary for vitamin B12 digestion
94
What do chief cells do?
Secrete proenzymes pepsinogen and gastric lipse

INTERNAL MED IP/OP (9 decks)

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