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GI Flashcards

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1
Q

Ransons Criteria for pancreatitis

A 
Glucose >200 
Age >55
LDH >350
AST >250
WBC >16,000
  • 3 or more= likely pancreatitis
    Less than 3= unlikely
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2
Q

Clinical manifestations triad for chronic pancreatitis

A

1) calcifications (seen on AXR)
2) steatorrhea
3) DM

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3
Q

Pathoneumonic sign for pancreatic cancer

A

Painless jaundice

*courvoisier’s sign: non tender palpable gallbladder with jaundice

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4
Q

Hamman’s Sign/ Hamman’s Crunch

A

Crunching sound synchronous with the heartbeat over the precordium in spontaneous mediastinal emphysema

**Associated with Boerhaave syndrome (esophageal rupture)

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5
Q

Anti-mitochondrial antibodies are hallmark for

A

Primary biliary cirrhosis

*puritis and hyperpigmentation are s/s

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6
Q

Grey Turner sign

A

Flank ecchymosis affiliated with pancreatitis

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7
Q

Buzz words for Ulcerative Colitis

A
  • only colon, rectum always involved
  • LLQ colicky pain
  • bloody diarrhea
  • complications are primary sclerosing cholangitis, CA, toxic mega colon
  • smoking is protective
  • uniform inflammation (stovepipe sign)
  • P-ANCA
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8
Q

Buzz words for Crohns

A
  • entire GI tract (MC terminal ilium)
  • RLQ pain
  • transmural skip lesions with fistula sand granulomas (cobblestone)
  • string sign on barium study
  • ASCA +
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9
Q

Schilling Test

A

Vitamin B12 deficiency antibody testing.

*antibodies to gastric parietal cells preventing the secretion of intrinsic factor

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10
Q

Vitamin deficiency seen with MCV >115 and hyper segmented neutrophils

A

B12 or Folate (B9) deficiency

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11
Q

Location of B12 absorption

A

Terminal ilium

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12
Q

Current jelly stools

A

Intussiception

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13
Q

Etiologies of peptic ulcer dz

A
  • H. Pylori (MC)
  • NSAIDS (2nd)
  • zollinfer-Ellison syndrome (gastrin producing tumor)
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14
Q

4 tests for H. Pylori infection of the stomach

A
  • rapid urease rest of the bx taken with endoscopy
  • urea breath test
  • H. Pylori stool antigen
  • serological antibodies
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15
Q

MC cause of upper GI bleed

A

PUD

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16
Q

Triple therapy for H. Pylori induces PUD

A
  • Clarythromycin
  • Amoxicillin
  • PPI
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17
Q

Quadruple therapy for H. Pylori induced PUD

A
  • PPI
  • Bismuth
  • tetracycline
  • metronidazole
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18
Q

Diagnostic study and tax of diverticula dz

A

CT scan (barium enema CI)

Tx: cipro or Bactrim + metronidazole

*fiber will help

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19
Q

Management of esophageal varacies

A

1) endoscopic ligation
2) octreotide: DOC in acute bleed
3) balloon tampanade
4) TIPS procedure

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20
Q

Long term management of esophageal varacies to prevent rebleed

A

Beta blocker

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21
Q

What is the MC type of gastric cancer

A

Adenocarcinoma

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22
Q

Risk factors for gastric cancer

A

H. Pylori ***

Cured or pickled foods, nitrates

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23
Q

Gastric carcinoma biopsy finding

A

Linitis plastica : diffuse thickening of the stomach wall

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24
Q

Charcot’s triad

A

For acute cholangitis

1) fever
2) jaundice
3) RUQ pain

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25
Reynolds pentad
For acute cholangitis Charcots triad PLUS 4) AMS 5) shock
26
Antibiotic treatment for acute cholangitis
Unasyn or zosyn
27
MC organisms causingacute cholecystitis
MC= E. coli Klebsiella Enterococcus
28
Boss sign
Referee pain to the RIGHT shoulder in acute cholecystitis *dont confuse with kehr sign which is referee pain to LEFT shoulder from phrenic nerve irritation associated with splenic rupture
29
MC causes of fulminant hepatitis
MC=acetaminophen overdose 2) drug reaction 3) viral 4) Reye’s (ASA in kids)
30
Clinical manifestations of hepatitis
1) encephalopathy: vomiting , AMS , ASTERIXIS 2) coagulopathy: decreases hepatic production of coagulation factors 3) HIGH AMMONIA
31
Fulminant hepatitis management
*liver transplant is definitive treatment FOR ENCEPHALOPATHY : 1) lactulose : lactic acid neutralizes ammonia 2) Rifaximin, neomycin: decrease ammonia production 3) Protein restriction
32
Hep A transition and manifestations
Feco-oral transmission -prodromal phase with SPIKING fever
33
Hep E transmission
Water born outbreak * highest mortality during pregnancy
34
Hep C transmission ; likelihood to become chronic
Parenteral transmission( IVDA) *80% get chronic infection
35
Hep C management
Pegylated interferon *screen for Hcc
36
Hep D transmission
Requires hep B first to coinfect or superinfect
37
Hep B transmission
Parenteral, sexual
38
Lab value associated with hepatocellular carcinoma
-high alpha-fetoprotein
39
Clinical manifestations of celiac dz
1) malabsorption : diarrhea | 2) dermatitis herpetiformis: on extensor surfaces
40
Antibodies found in celiac dz
1) Endomysial IgA Ab | 2) transglutaminase Ab
41
Definitive diagnostic study for celiac dz
Small bowel bx
42
ROME IV criteria for IBS
*reccurent abdominal pain at least 1 day a week for 3 months with 2 of the following: 1) relieved with defecation 2) change in still frequency 3) change in stool form
43
What is the most common cause of intermittent solid food dysphagia and food impaction?
Schatzki's ring (also known as B ring) occurs at the gastroesophageal junction at the distal margin of the lower esophageal sphincter.
44
What is the treatment for diverticulitis?
cipro or bactrim + metronidazole
45
CT findings in a patient with acute messenteric ischemia
``` thumbprinting Pneumatosis intestinalis (submucosal gas)_ ```
46
What are potential causes of nonocclusive mesenteric ischemia?
Septic shock, hypovolemia, potent vasopressors.
47
most specific tumor marker for pancreatic cancer
CA19-9
48
3 Types of colon polyps and their probability for malignancy
1) pseudopolyp: not cancerous, due to IBD 2) Hyperplastic: low risk 3) Adenomatous polyps: normally become malignant in 10-20yrs
49
3 types of adenomatous polyps
1) tubular adenoma: nonpedunculated (MC and best prognosis) 2) tubulovillous: mixture of both 3) villous adenoma: high cancer risk
50
Tumor marker used for colorectal cancer
CEA
51
Plumer Vinson Syndrom
1. dysphagia 2. esophageal webs 3. iron deficiency anemia *may have atrophic glossitis, shelties, splenomegaly
52
What is the most common type of esophageal cancer worldwide vs in the USA?
USA=adenocarcinoma (MC as a complication of GERD that lead to Barrett's esophagus) World=squamus cell
53
What is Boas sign
reffered RUQ pain to the right shoulder seen in acute cholecystitis.
54
What is the gold standard for diagnosis of sauce cholecystitis ?
HIDA scan. **after initial RUQ u/s
55
Manifestations of cirrhosis
1) encephalopathy; tx with lactulose or rifaximin 2) esophageal varacies 3) SBP, spontaneus bacterial peritonitis (infected ascitic fluid) 4) ascites, astrixis, gynecomastia
56
What classification system is used to stage liver cirrhosis?
Child-Pugh *based on bilirubin, albumin, INR, ascites, and encephalopathy
57
Diagnostic chest of choice for pancreatitis
CT abdomen
58
What part of the GI tract does celiac dz effect
small intestine
59
What type of diagnostic studies are contraindicated in acute colitis?
1) colonoscopy 2) barium enema ***upper GI series with small bowel follow through is TOC for chrons ****flex sig is the treatment of choice for UC
60
An "apple core" lesion found on barium enema is a classic finding of what?
Colon cancer
61
What is the reservoir for giardia lamblia protozoa?
Beavers! IT is then transmitted though contaminated water in streams/wells -AKA Beaver fever, aka Backpacker's diarrhea
62
Presentation of Giardia Lamblia infection
Frothy, greasy, foul diarrhea with NO blood or pus , cramping, bloating - trophozoites/cysts in the stool - Treat with metronidazole
63
Hallmarks of Amebiasis
- Entamoeba histolytica parasite transmitted fecal-oral. MC seen in international travel - Presents as GI colitis, dysentery, Amebic liver abcess - Metronidazole to treat, add on chloroquine if there is an abcess
64
What is the MC cause of chronic diarrhea in patients with AIDS?
Cryptosporidium
65
Constipation medications
1) Fiber/Bulk forming laxatives (absorb, h2o) 2) Osmotic laxitives (h2o retention) - Polyethylene Glycol: miralax, golytely - Lactulose - Sorbitol - Saline laxitives: milk of mg, mg citrate 3) Stimulant laxitives (increase acetylcholine-regulated GI motility) - Bisacodyl, dulcolax

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