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GI Flashcards

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1
Q

green vs black stones: etiology

A

green: cholesterol (5 Fs)
black: hemolysis

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2
Q

Cholelithiasis: management

A

if surgical candidate: cholecystectomy

if not surgical: ursodeoxycolic acid

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3
Q

Cholecystis: DX

A

RUQ US (pericholecystitic fluid and thickened GB wall +/- gallstones)

If this is negative, but high suspicion, get HIDA

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4
Q

Choledocolithiasis: DX

A

RUQ US showing obstruction

if this is negative but high suspicion, get MRCP

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5
Q

Choledocholithiasis: complications (2)

A

hepatitis

pancreatitis

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6
Q

Cholangitis: Path and TX

A

gallstone in CBD + infection

TX: first emergent ERCP, give antibx (for GNR and anarobes) on the way to OR

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7
Q

Cholangitis: antibx options

A 
cipro + metronidazole
or
ampicillin-gentamicin + metronidazole
or
pip-tazo (but try to avoid)
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8
Q

Esophagitis: causes (5) and definitive diagnosis

A 
Pill-induced
Infectious
Eosinophilic
Caustic
gErd

DX: EGD with biopsy always

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9
Q

Esophagitis: clinical features

A

odynophagia and dysphagia

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10
Q

Pill-induced esophagitis: speicifc meds (4)

A

NSAIDs
anitbx (specifically tetracycline)
Bisphosphonates
HAART

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11
Q

Infectious esophagitis: causes (4) and clinical features

A

Candidia: oral thrush (treatment with oral fluconazole, as in vaginal candidiasis)

HSV (oral lesions, ulcers in multiple stages of healing; tx with val/acyclovir)

CMV (no typical appearance, get biopsy, tx with gangcyclovir)

HIV (look for other oppurtunistic infections; start on HAART)

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12
Q

Eosinophilic esophagitis: risk factors and biopsy findings

A

risk factors: atopy, allergies, and asthma triad

Dx: EGD with biopsy showing >15 eos per HPF

Tx: first trial on PPIs, if this fails, use aerosolized steroids

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13
Q

Corkscrew esophagus =

A

diffuse esophageal spasm

Esophagus that looks like beads on a string

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14
Q

Barium swallow showing narrowed lumen: diff dx

A

schatskis ring vs cancer

get biopsy

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15
Q

IDA and dysphagia

A

plummer vinson syndrome

NOTE: esophageal webs have risk of transforming into cancer, so F/u with EGDs regularly

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16
Q

Stricture vs cancer: distinguishing featrues

A

stricture: barium swallow showing symmetric luminal narrowing
cancer: assymmetric luminal narrowing

NOTE: EGD with Bx is definitive

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17
Q

Peptic ulcer disease: etiologies (5) and appearance/clinical features

A

H. pylori (especially suspect if duodenal ulcer, single)

NSAIDs (shallow and multiple)

cancer (heaped margins and necrotic center)

curling ulcer (think burn victims)

cushing ulcer (increased ICP with brain injury, steroids, and ventilators)

ZES

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18
Q

Multiple ulcers refractory to PPIs, and diarrhea

A

ZES

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19
Q

Triple therapy for H. Pylori

A

clarithromycin
amoxicillin (mtz if penicillin allergy)
PPI

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20
Q

Diagnosis of ZES

A

(1) gastrin level (>1600 diagnostic, <250 nl, otherwise can do secretin stim test)
(2) if gastrin level concerning, f/u with somatostatin receptor scintography (SRS)

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21
Q

H. Pylori infection: most accurate vs initial test

A

initial: serology

most accurate: EGD with biopsy

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22
Q

H. Pylori infection: test for eradication

A

stool antigen

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23
Q

Chronic abdominal pain after eating in someone with DM

A

gastroparesis

DM with neuropathy of vagus nerve (most also have peripheral neuropathy)

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24
Q

Habitual marijuana use with vomiting every so often

A

cyclic vomitting syndrome

maybe from THC withdrawal

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25
Cyclic vomitting syndrome: TX
stop THC | use metaclopramide or erythromycin (IV, if severe)
26
Signet ring cells
gastric adenocarcinoma
27
Gastroparesis: TX in chronic vs acute disease
stable disease: metaclopromide (PO) flares: erythromycin (IV) NOTE: domperidone not used in US, but sometimes is obtained for compassionate use
28
Definition of acute vs chronic diarrhea
acute: <2weeks duration chronic: >4weeks duration Perceived change in quality of stool or amount or frequency OR objectively elevated amount (>200grams)
29
Enterotoxic diarrhea: pathogens (6)
``` C. diff ETEC vibrio cholera staph aureus B. cereus giardia ```
30
Invasive diarrhea: pathogens (
``` Salmonella Shigella EHEC (O157-H7) Campylobacter Ameba histolytica ```
31
Association with a. histolitica invasive diarrhea
immunocompromise, specifically HIV/AIDS
32
W/u invasive diarrhea
postive for stool WBC/lactoferrin and RBCs Get stool cx and colonoscopy if cx positive, worry about infection if colonoscopy positive, worry about IBD
33
C. diff infection: best test
c. diff NAAT
34
Severe C. diff: TX
Severe C. diff is when there is leukocytosis, megacolon, or azotemia PO vancomycin (intraluminal protection) AND IV metronidazole (extraluminal)
35
HUS: TX
plasma exchange
36
Stool osmolar gap =
measured osmoles (290) - calculated osmoles (2x [Na + K])
37
Secretory vs osmotic/malabsoprtive diarrhea: stool osmolar gap
secretory: <50 | osmotic/malabsorptive: >100 (other things in stool that bring Na and K down and increase gap)
38
Bilirubin and ALP in cholecystits vs choledocholithiasis/cholangitis
cholecystis: mild elevation in total bili (1-4) and direct bili (d/t passage of sludge/pus in the CBD); nl ALP choledocholithiasis: elevated total bili and ALP
39
Best imaging test for trauma pt with gross hematuria, difficulty urinating, and blood at the meatus/suprpubic pain
restrograde cystourethrogram
40
Best imaging test for person with blunt genitourinary trauma who is HDS
CT abdomen w/contrast
41
brick-red urate crystals in an infants diaper
sign of mild dehydration may be associated with breasfeeding failure jaundice and unconjugated hyperbilirubinemia (from increased enterohepatic circulation of bili)
42
Breast milk jaundice: clinical features
starts age 3-5 days, peaking at 2 weeks; adequate breastfeeding and normal exam with no dehydration and no issues with feeding that would point to breast feeding jaundice
43
Increased gastric residual volume, vomiting, and abdominal distension in a preterm neonate
NEC Get abdominal Xray looking for pneumatosis intestinalis
44
gold standard imaging test for malrotation in an infant
upper GI contrast series study
45
Typical age for midgut volvulus
<1 month old
46
Colonoscopy showing cyanotic mucosa and hemorrhagic ulcerations
ischemic colitis
47
SAAG >1.1
portal HTN (from rCHF or cirrhosis)
48
SAAG <1.1
malignancy pancreatitis nephrotic syndrome TB Increased permeability of capillaries
49
Low grade fever, abdominal discomfort, and AMS in pt with cirrhosis and ascites
SBO
50
Test abnormality in SBO
Reitan trail test (timed connect the numbers test) detects subtle mental status changes in SBO
51
Marked pruritus and elevated total bile acids and/or aminotransferases in pregnancy =
intrahepatic cholestasis of pregnancy NOTE: jaundice is unusual in this condition and requires further w/u (evaluation for acute fatty liver of pregnancy)
52
Diagnostic criteria for SBO (2)
positive ascites fluid culture (often GN organisms like E coli and klebsiella) + Neut count >250
53
SBO: TX
empiric: 3rd generation cephalosporins (cefoxatime) ppx: fluoroquinolones
54
Elevated ALP in patient with UC should raise suspicion for
PSC
55
Best diagnostic imaging test fgor acute diverticulitis
CT abdomen with contrast
56
Best diagnostic tests for acute hep B infection
HBsAg and IgM anti-HBc
57
Does secretory diarrhea wake someone up from sleep?
yes (this distinguishes it from osmotic diarrhea)
58
Pathogenesis of gilbert syndrome
AR or AD mutation causing a decrease in UDP-glucuronosyltransferase activity and increase in unconjugated bili (<3) during times of stress
59
Duodenum absorbs ____(4)
folate, iron, calcium, and carbs (FICC)
60
Terminal ilium absorbs ____(3)
bile acids fat soluble vitamins (ADEK) vitamin B12
61
100g fat test for malabsoprtion postive finding
>14 g/day in stool over 72 hours
62
Location of highest involvement in celiac disease
proximal duodenum iron deficiency, osteoporosis
63
Malabsorption +brain/joint/lymph node involvement and PAS positve organisms
T whippeli infection
64
whipples disease: tx
TMX-SMP | doxycycline
65
Older pt with pmh of constipation with postprandial LLQ pain relieved by BM
diverticular pain (spasms)
66
Imaging to r/o perforation or obstruction
upright KUB
67
Diverticulitis: TX
Cipro + metronidazole gent/amp + metro pip tazo (dont pick this though as is too broad and expensive)
68
Primary prophylaxis for esophageal variceal hemorrhage
endoscopic variceal ligation or propranolol/nadolol (non-selective beta-blockers)
69
D-xylose evaluates absorption in which part of the small bowel?
small bowel
70
Drug used to treat colon cancer
beveciumab (VEGF-i)
71
3 options for colon cancer screening in asymptomatic population
``` colonoscopy q10 or sigmoidoscopy q5y + FOBTq3yr or FOBTq1yr ```
72
HNPCC cancer and family associations
Colorectal cancer Eendometrial cancer Ovarian cancer 3,2,1 (3 cancers in family, 2 generations, 1 premature death from cancer)
73
Peutz-Jeugers:cancer location
SMALLBOWEL, do EGD | not crc
74
Causes of cirrhosis
``` Viral hep B/C Wilsons Hemochromatosis Alpha 1 antitrypsin PSC PBC EtoH NASH/NAFLD Something else ```
75
Hep C from ___
IVDU
76
Hep B from____
sex
77
First and best tests for Wilsons
1st: slit lamp best: liver biopsy showing increased copper
78
Mainstay therapy for wilsons vs hemochromatosis
wilsons: penacillamine hemachromatosis: phlebotomy
79
Best test to diagnose alpha-1 antitrypsin and findings
biopsy (shows PAS positive macrophages, same as in whipples disease)
80
PSC: diagnostic tests
MRCP (beads on a string) | ERCP (onion skin fibrosis)
81
PSX: TX
best: transplant while waiting can give urso-deoxycolic acid
82
PBC: Imaging findings
NOTHING Get biospy if supsect PBC
83
variceal bleeding: ppx and acute tx
acute: octreotide ppx: nadolol, propronalol
84
Ppx for SBO: indications and drug
indications: SBO once before or total protein <1.0 TX: fluoroquinolone
85
Hepatocellular cancer: diagnostic w/u
Sceening with RUQ US and AFP diagnosis with triple phase CT
86
AVMs assoicated with
aortic stenosis
87
Conditions in which there is elevated amylase
conditions that involve vomiting gallbladder inflammation pancreatitis (since not as specific, get either lipase or amylase-p)
88
Most sensitive test for prognosis in acute pancreatitis
BUN
89
Early complications of acute pancreatitis
ARDS HypoCa (caponification) pleural effusion ascites
90
SIRs following acute pancreatitis
infection, get biopsy and start with meropenam until cultures and sensitivities come back
91
SBO or abdominal fullness after acute pancreatitis =
pancreatic pseudocyst
92
Intrahepatic causes of unconjugated hyperbilirubinemia
criggler-Nijar (really bad form and Gilbert-type form) and | Gilberts
93
Intrahepatic causes of conjugated hyperbilirubinemia
Dubin-Johnson (black liver) | Rotors
94
Hep C: TX
``` Protease inhibitors (direct-acting antagonist) i.e. borceprevir ```
95
Carcinoid syndrome: TX
octreotide
96
Hepatorenal syndrome: TX
somatostatin (octreotide), midodrine
97
Name a somatostatin drug
octreotide
98
Orthodeoxia found in ___
hepatopulmonary syndrome orthodeoxia = hypoxia upon sitting upright
99
Causes of larger than nl AST/ALT ratio (3)
EtoH NASH Medications that can cause liver dysfunction
100
Bilirubin and ALP in early PBC are ____
normal (bili) and elevated (ALP) NOTE: early PSC is the same
101
PBC: complications
cirrhosis | osteoporosis
102
PBC: physical exam finding
xanthelasma/xanthoma
103
PBC and PSC: TX
cholestyramine or ursodeoxycolic acid
104
Tests that you can do with lacose intolerance (4)
Hydrogen breath test (positive) Stool test for reducing substance (positive) stool pH (low) stool osmotic gap (high)

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