GI Flashcards
1
Q
TPN + RUQ pain
A
Cholesterol gallstones 2/2 GB stasis
2
Q
Pneumaturia
A
Colovesical fistula
(Diverticulitis, Crohn, or CRC)
3
Q
Epigastric burning + postprandial bloating
A
PUD
(2/2 H. pylori, NSAIDs, GERD)
4
Q
Duodenal ulcer in young pt
A
H. pylori
(Triple PAC or BisMuTh PPI Quadruple Therapy)
5
Q
Abd pain that improves w/ eating and worse w/ empty stomach; wakes pt up at night
A
Duodenal ulcer
6
Q
Transudative pleural effusion thru small diaphragmatic defects in setting of ascites
A
Hepatic hydrothorax
7
Q
Cause of ascites
A
Splanchnic vasodilation from cirrhosis-induced portal HTN
8
Q
Platypnea + orthodeoxia
A
Hepatopulmonary syndrome
(increased dyspnea and oxygen desaturation respectively while upright)
9
Q
Intrapulmonary vascular dilations in setting of chronic liver disease
A
hepatopulmonary syndrome
10
Q
Ascites Tx
A
Fluid & salt restriction, diuretics
(Spironolactone + Furosemide)
11
Q
Diagnostic test for Zenker’s diverticulum
A
Contrast esophagram
12
Q
Wilson’s disease
(Copper) age of onset
A
5-35yo
13
Q
More specific LFT for liver injury
A
ALT
14
Q
Esophageal variceal PPX (non-bleeding)
A
- Nonselective BBs (propranolol, nadolol), or
- Endoscopic variceal ligation (contraindication to BBs)
15
Q
“Alligator skin” on colonoscopy
A
Laxative abuse
(melanosis coli)
16
Q
Dark brown colonic mucosal pigmentation on colonoscopy
A
Laxative abuse
(factitious diarrhea)
[Melanosis coli]
17
Q
Hospital worker
A
Factitious
18
Q
Symptom relief after BM
A
IBS
19
Q
Intense pain to lightly brushing periumbilical skin
A
VZV reactivation
(shingles; pain may precede dermatomal rash by several days)
20
Q
Biggest reversible risk factor for pancreatic cancer
A
Smoking
21
Q
Biggest reversible risk factor for MALT lymphoma
A
H. pylori
22
Q
Tx for acetaminophen-induced ALF
A
Liver transplant
23
Q
Most common cause of death in ALF (acute liver failure)
A
Cerebral edema
24
Q
Secretin stimulation test
A
2nd line test for non-diagnostic elevations in fasting serum gastrin
(secretin specific to gastrinoma cell stimulation
[inhibits normal gastric G cells]); 3rd line = Calcium infusion study
25
**Achlorydria**
Failure of gastric acid secretion, leading to elevated gastrin levels that mimic ZES or PUD
26
High fasting serum gastrin level
Zollinger-Ellison Syndrome
| (ZES; gastrinoma)
27
D-Xylose
Monosaccharide that does not require enzymes to be absorbed by the SI
28
D-xylose passes unabsorbed
**Celiac disease**
(malabsorption due to villous atrophy of the small intestine)
29
LGIB in young pt w/ no risk factors. Next step?
**Anoscopy**
(in-office) (likely hemorrhoids or rectal fissure)
30
N-acetyl-p-benzoquinone mine (NAPQI)
Hepatotoxic component of acetaminophen normally detoxified through glucuronidation
31
5-HIAA
Carcinoid Syndrome Dx
32
Carcinoid Dx
Elevated 24hr urinary 5-HIAA
33
Episodic flushing
Carcinoid syndrome
34
Most common cause of liver mass
liver met
| (from CRC or pancreatic cancer)
35
+FOBT + Liver mass
**CRC + Liver met**
36
New-onset anemia in elderly pts
GI bleed until proven otherwise!
| (colonoscopy & endoscopy)
37
All cirrhotics w/ ascites are ____ until proven otherwise!
**SBP**
| (diagnostic paracentesis)
38
Palpable **NONTENDER** gallbladder
Pancreatic cancer
(Courvoisier sign; think painless jaundice = pancreatic cancer)
39
\_\_\_\_ in cirrhosis leads to spider angiomas and palmar erythema
**Hyperestrinism**
(2/2 impaired hepatic metabolism of circulating estrogens (CYP450), which lead to vascular wall dilation)
40
Anti-SM vs. Anti-Smith
* Anti-Smooth Muscle = AIH (Autoimmune Hepatitis; ANA+)
* Anti-Smith = SLE (+Anti-dsDNA, Anti-phospholipid)
41
Epigastric pain improved when leaning forward
**Chronic pancreatitis**
| (vs. pericarditis = chest pain)
42
Pancreatic calcifications on CT
Chronic pancreatitis
43
RUQ pain + fever post-operative or
in hospitalized pt
Acalculous cholecystitis
44
D-penicillamine
Copper chelator
| (Wilson disease tx)
45
**MALT Lymphoma**
90% have hx of H. pylori
(smoking is NOT related to MALT, it is associated to gastric adenocarcinoma)
46
Abd pain after cholecystectomy
**Postcholecystectomy Syndrome**
(PCS)
* Dx: Abd US —\> ERCP
47
Elevated LFTs + ANA+
**Glucocorticoids**
48
Marker to screen for HCC in HCV or cirrhosis pts
**AFP**
49
ACS drug that elevates LFTs
**Statins**
50
**Ursodeoxycholic Acid (UDCA)**
Aka ursodiol: dissolves bile acids;
Treats: PBC, PSC, & cholecystitis in pt ineligible for surgery;
Hydrophilic bile acid used in treatment of PBC to delay histologic progression, improve sx, and possibly survival
51
**Pruritus & fatigue** in middle-aged woman
**PBC!**
52
Bowel wall thickening, pneumatosis intestinalis & thrombus on abd CT
Mesenteric ischemia
53
CBD dilation on Abd US or CT
**Acute Cholangitis** (AC)
54
If not treated promptly (ERCP within 48 hours), acute cholangitis can lead to \_\_\_\_
**Septic shock**
55
Intravenous Drug Use
HIV, HCV, Hepatitis, Endocarditis, Empyema
56
The major cause of morbidity & mortality in alcoholic liver disease
Esophageal varices
57
Tx of suspected variceal hemorrhage
| (in cirrhosis pt)
AEIOVarices
* Abx
* Endoscopy (urgent)
* IVF volume resuscitation
* **IV Octreotide**
58
Screen pt with ZES for \_\_\_
**MEN1**
| (PTH, ionized calcium, prolactin)
59
Sheep, dogs, or Southwest
**Echinococcus tapeworm**
| (hydatid liver cysts)
60
Long-term OCPs
**Hepatic adenoma**
61
Elevated alk phos + GGT
Biliary compression or obstruction
62
Most common source of liver metastasis
Colon cancer
63
Elevated AFP, normal B-hCG
**HCC**
64
Worsens GERD
Lying down, chocolate, peppermint
65
Diarrhea that occurs even during fasting or sleep
secretory diarrhea
66
Drug-induced pancreatitis
Diuretics, Valproic acid, MNZ
67
5-ASA
Mesalamine (IBD)
68
Empiric Tx for traveler’s diarrhea
Ciprofloxacin
| (E. Coli)
69
Tx for giardiasis
**MNZ**
70
Cancer caused by H. pylori
MALT lymphoma or gastric adenocarcinoma
71
AST:ALT 2:1
Alcoholic hepatitis
72
Most common site of metastasis in colon cancer
liver
73
Smoker
think CANCER (or COPD)
74
**PBC**
Women; +AMA
75
**PSC**
Men; UC; +pANCA
76
Cholestatic pattern
Predominantly elevated alk phos + mildly increased AST/ALTs
77
Autoimmune rxn to gliadin peptide
Celiac disease
78
Fatigue + Foul-smelling greasy diarrhea
Celiac disease
79
Nonabsorbable disaccharides
Lactulose, lactilol —\> Tx for hepatic encephalopathy
80
Hepatic encephalopathy Tx:
* Lactulose
* Rifaximine
* Limit protein intake
81
Melena
UGI Bleed
(**PUD** from **H. pylori** vs. **NSAIDs; Varices** [cirrhosis])
82
Elevated alk phos + jaundice
Biliary obstruction:
**Pancreatic/biliary cancer** vs. **CBD stricture** (pain*LESS)* vs. **gallstones** (pain*FUL)*
83
Conjugated Hyperbili + PainLESS
**Cancer** or **CBD strictures**
84
Conjugated Hyperbili + PainFUL
**Gallstones**
85
Jaundice + Urine negative for bilirubin
**Unconjugated hyperbilirubinemia**
86
Cholestasis
**Conjugated bilirubinemia**
87
Urine+ for bilirubin
| (“dark urine”)
**Conjugated hyperbilirubinemia**
*because unconjugated bilirubin is bound to albumin in blood and not water-soluble*
88
Impaired glucose control in diabetics is seen w/ ____ deficiency
**Chromium**
89
Alopecia + hypogonadism is seen in ___ deficiency
**Zinc**
90
Thyroid dysfunction + Cardiomyopathy is seen in ___ deficiency
**Selenium**
91
Dermatitis, Diarrhea, Dementia
**Pellagra** (Niacin [**B3**] **Deficiency**)
- can be caused by INH
92
Impaired taste is seen in ____ deficiency
**Zinc**
93
Anti-mitochondrial antibody+
PBC
| (Primary biliary cholangitis)
94
Charcot triad
Fever, jaundice, RUQ pain
| (Ascending cholangitis)
95
Bronze diabetes
**Hemochromatosis**
| (pigmentation + DM)
96
Clay-colored stools
lack of bilirubin
97
Clay-colored stools + wt loss
CBD cancer
| (biliary cancer)
98
Tx of CBD cancer
**ERCP**
| (endoscopic US first)
99
Migratory thrombophlebitis
**Pancreatic Cancer**
100
Courvoisier’s Sign
Palpable distended GB
| (Biliary malignancy)
101
Virchow’s Node
L supraclavicular adenopathy
| (GI cancer)
102
DES Tx
CCBs
| (or NTG)
103
Halitosis
Zenker diverticulum
| (proximal esophageal pouch)
104
Periumbilical pain out of proportion to physical exam findings
**Bowel ischemia** from vascular obstruction
105
Post-prandial R shoulder/subscapular pain
**Cholecystitis or biliary colic** 2/2 gallstones
(referred pain)
106
Dysphagia post-alkali ingestion
**Schatzki Ring**
| (lower esophageal ring)
107
Dysphagia + regurgitation
**Achalasia**
108
Sideropenic dysphagia
**Plummer-Vinson syndrome**
(premalignant to SCC; triad: Iron-deficiency anemia, dysphagia, esophageal webs)
109
Corkscrew esophagus on barium swallow
**DES**
| (Diffuse Esophageal Spasm)
110
Asymmetric esophageal narrowing on barium swallow
**Adenocarcinoma** (in setting of chronic GERD)
111
Dysphagia to solids but not liquids
Esophageal stricture
(Peptic stricture) or early esophageal cancer
112
Dysphagia of solids first, then liquids
**Esophageal cancer**
Or:
* *If intermittent:* lower esophageal ring
* *If progressive but no wt loss:* Peptic stricture
113
Air under diaphragm or retroperitoneum on abd XR
**Perforation**
114
LLQ pain in elderly
**Diverticulitis**
| (Abd CT)
