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STEP 2 AG > GI > Flashcards

GI Flashcards

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1
Q

Hgb to give RBC transfusion

A

<7
<9 w/ ACS
If the PT is in hemorrhagic shock

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2
Q

Pt w s/s appendicitis

A

Just get them an appy they don’t need diagnostic imaging

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3
Q

Kid swallows a foreign body

A

If asymptomatic can observe for 24 h then repeat XR, flex endoscope

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4
Q

Liver probs in a preggo

A

Acute cholangitis: beck’s triad (RUQ pain, jaundice, fever) will have slightly elevated AST and ALT, not like acute fatty liver dz which will be super super high
Intrahepatic cholestasis of pregnancy=3rd tri, itchy palms and soles, high bile acids>10 (IUFD>100), tx ursodeoxycholic acid
Acute fatty liver disease of pregnancy=jaundice, FULMINANT LIVER FAILURE—>plt<100k, hypoglycemia, microvesicular intrahepatic emergency 3rd tri get baby out
HELLP=HTN, plt<100k
Pre-eclampsia=HTN

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5
Q

Diarrhea

A

Inflammatory (bloody)
Osmotic (Stool Osmotic Gradient>125)
Secretory (SOG<50, PT with prior abd surgery, >1L/day, diarrhea when fasting)

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6
Q

Critically ill patients with RUQ pain

A

Acalculus cholecystitis, high suspicion in ICU, shock, 2/2 ischemia leading to infection

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7
Q

Hepatic cyst

A

NOT BILIARY ATRESIA (infants), kids <10 yo, high LFTs, pain, jaundice, abdominal mass

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8
Q

Tracheoesophageal fistual

A

most common is distal fistula = abdominal distentsion, stomach acids into lungs = pneumonia

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9
Q

diverticulosis

A

MC cause of bright red poop, arterial bleeding, hemodynamic instability/lightheadedness

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10
Q

iron deficiency anemia in an old person

A

GI bleed, negative FOBT does not rule out, need scope

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11
Q

Spontaneous bacterial peritonitis

A

Ascites, protein<1, SAAG>1.1, PMNs>250, +clx, bact extravasation, paralytic ileus=severe, give abx

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12
Q

Zenker diverticulum

A

Barium swallow DO NOT SCOPE RISK OF PERF, caused by UPPER sphincter dysfxn +esophageal dysmotility, herniation between cricopharyngeal muscles

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13
Q

Porcelain gallbladder

A

Chronic inflammation, inc risk of adenocarcinoma

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14
Q

Post op ileus

A

> 3 days, no flatus, distended small AND large bowel, opiates, ondansetron worsen
Ddx mech bowel obstruction weeks-yrs after abd surgery

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15
Q

GERD - when to go right to scope

A

Alarm sx (anemia, vom, odynophagia/dysphagia, weight loss, bleeding), male >50 yo, >5 y sx, cancer RFs

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16
Q

Pancreatitis shock

A

Increased vascular permeability, CT calcifications=chronic

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17
Q

Acute liver failure

A

LFTs>1000, encephalopathy, PT>100, renal probs, need transplant

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18
Q

Celiac dz

A

ttg, but will be low in cases of selective IgA def, get total IgA, urine d-xylose to dx absorbed in proximal small intestine, can be low in SIBO small intestinal bacterial overgrowth give 4 weeks of rifamaxin and retest

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19
Q

Diverticulitis

A

Hx of constipation low fiber diet, abd CT to dx, XR nonspecific

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20
Q

Hematemesis causes

A

Boerrhave=Transmural tear, chest pain, L sided pleural effusion amylase+
Mallory-Weiss=mucosal tear
Pancreatitis=epigastric pain
Gastric mucosal erosion=aspirin + alcohol, cocaine
Esophageal varices=cirrhosis, give fluids abx octreotide then endoscopy, balloon tamponade if uncontrolled bleeding then repeat endo, Bb ppx, give plt <70k, PRBCs <9
PUD=coffee ground

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20
Q

Pt w PUD

A

MC causes are NSAIDs or h pylori, if no hx of NSAID use give triple therapy

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21
Q

Hyperbili adult

A

Conjugated (always pathologic):
Dubin-Johnson (hepatocytes can’t excrete bili, jaundice when stressed, black liver on bx)

Unconjugated:
Gilbert (not severe, benign elevated bili)
Crigler-Najjar (more severe)

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22
Q

Pancreatic cancer

A

Obstructive (alk phos, conj bili), dx CT CT CT CT CT CT ca19-9 is better for tracking post-op, palliative endoscopic stent

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23
Q

Where is the stone?

A

Cystic duct=alk phos IS NORMAL, transaminases can be a little elevated
Common bile duct=jaundice, high LFTs

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24
Liver lesions
Hepatic adenocarcinoma=young women OCPs, abd US hyperechoic CAN RUPTURE hemorrhage Hepatocellular carcinoma=mass w satellite lesions, RFs chronic liver dz hepatitis Hydatid cyst=echinococcus cystic not solid mass, egg shell calcifications, septations/daughter cysts drain + albendazole Nodular hyperplasia=also young women, arterial supply, US shows blood flow Nodular regeneration=cirrhosis Multiple lesions=mets most likely Abscess=DM peritonitis, abx drain Entamoeba histolytica=travel bloody diarrhea metro+paroromycin
25
Hepatic encephalopathy
Causes=SBP, nitrites (hemolysis, protein), hypovolemia, give fluids, REPLETE K, lactulose, if NOT RESPONSIVE TO LACTULOSE try rifamaxin, then try neomycin LACTULOSE TO HELP MENTAL STATUS
26
Upper GI bleeding
High BUN (NOT high w lower GI)
27
Gall stone ileus
Sort of an SBO picture that comes and goes then eventually gets bad, air in hepatic ducts NOT EMPHYSEMATOUS CHOLECYSTITIS (=infx w gas producing organisms), tx surgery
28
Drugs that can cause pancreatitis
``` HI DIA HIV Immunosuppressants Diuretics IBD Anti-seizure/antibiotics ```
29
Difference between liver ischemia and acalculus cholecystitis
Both can happen in critically ill PT/shock/hypotension—>ischemia, hepatic ischemia will have HIGH HIGH HIGH AST/ALT and pretty nl alk phos and bili, cholecystitis will have high alk phos and bili, nl/slightly elevated AST/ALT
30
Causes of dysphagia
Oropharyneal vs esophageal Oro=neuro probs, age, get videofluoroscopic barium swallow Esophageal=dysmotility (achasia, can’t swallow solids or liquids at onset) or obstruction (progressive, stricture cancer etc, barium swallow or straight to EGD)
31
Esophageal spasm
Hot/cold foods, better w nitro, manometry
32
Psoas abscess
CT! Can’t diagnose w ultrasound
33
Crohn dz
Transmural
34
Primary biliary cholangitis
Middle age women, +AMA, itching, xanthomas, bone dz, tx ursodeoxycholic acid
35
Primary sclerosing cholangitis
Men, ulcerative colitis, +p-ANCA
36
Risk factor for c diff
Abx, decreased gastric acid
37
Colon cancer screening
>50, 10 y before FDR age at diagnosis, 8-10 y after dx of UC
38
Toxic megacolon
acute infx (C diff) OR may be first presentation of IBD!!, abd distention, bloody diarrhea, pt looks sick, Get abd XR
39
Gallstones tx
Asymptomatic=nothing Biliary colic=elective surg, ursodeoxycholic acid if poor surg candidate Infx=72 hr surg
40
Lactose intolerance
Malabsorption, dx hydrogen breath test
41
Femoral hernia
Surgery even if not incarcerated! Higher risk
42
Need to correct INR before surgery
Give FFP
43
Hep B
Serology during acute illness=HBsAg + IgM anti-HBc
44
FAP screening
10 yo sigmoidoscopy Q1, colonoscopy Q1 after first polyp, elective proctocolectomy
45
Trousseau’s syndrome
Migratory thrombophlebitis a/w cancer (pancreatic)
46
NAFLD
Insulin resistance causes increased FFA
47
Cholelithiasis preggo
Intermittent RUQ pain inc risk (estrogen + prog), conservative tx surgery only if severe recurrent
48
Cholangitis + pancreatitis
``` Charcot triad (RUQ pain, fever, jaundice) Dilated common bile duct on US, ERCP ```
49
SIBO
Roux-en-Y, steatorrhea and malabsorption of ADEK and B12 (may see macrocytic anemia) NOT DUMPING
50
Hemochromatosis
Men >40 women postmenopause Cardiomyopathy, Heberden nodes (DIPs), Arthropathy, Liver (HSM, cirr), a/w LYVer=lysteria, yersenia, vibrio vulnificans, dx Fe studies tx phlebotomy
51
Eosinophilic esophagitis
Men 20-30, intermittent meat food impaction, dx bx eos>15, tx diet + topical glucocorticoid
53
Liver tplant allograft rejection
12d post-op, bx PNM, eos in hepatic triads
54
Splenic rupture
atraumatic hem ca, EBV, infl (SLE, pancreatitis) + AC
55
Parenteral nutrition
<2w central line infx, >2w cholelithiasis
56
SBO
adhesions, NO AIR IN RECTUM
57
Esophageal rupture
+\- widened mediastinum, pleural effusion GREEN, stable esophagography unstable surg, TRAUMA PT
58
Ulcerative colitis
Mild <4 poops a day, mesalamine can do enema if rectosig only, mod-severe TNFa inh (infliximab)
59
ERCP complications
Pancreatitis (SOD) dx 2/3 epig pain lipase/amylase>3x nl imaging, ascending infx cholangitis, perf
60
Lap chole complications
Biliary leakage 2-10d alk phos bili nl ducts on imaging | Retained gallstone dilation
61
Thoracic gun shot wound
Below nipple T4 FAST equivocal + hemodynamic instability ex lap
62
Gastric cancer
Chinese IDA, mets to liver, DX EGD
63
Splenic abscess
Lap chole, IC or DM, LUQ pain, fever, can be 2/2 IE (esp pt w known valve dz), dx CT tx SPLENECTOMY
64
Niemann-Pick
sphingomyelin, tay-sachs +HSM +hyper-reflexia (tay sachs areflexia)
65
Ogilvie syndrome vs SBO
Ogilvie's: COLON, trauma/surg/infx/neuro probs, autonomic dysfxn, hypoK hypoMg, NG tube, neostigmine >48h >12cm SBO: SMALL BOWEL
66
Vascular ring
Extra aortic arch biphasic stridor dysphagia T3-4
67
Cirrhosis
HypoCa, Mg, albumin
68
Vomiting electrolytes
HypoCl, hypoK, metabolic alkalosis (high bicarb)
69
Ischemic hepatic injury
Hypotension (pt w shock) —> ^^^LFTs rapid onset
70
Bilious nonbilious vom <1mo
Bilious volvulus XR—>EGD | Nonbil—>pyloric stenosis

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