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GI Flashcards

1
Q

Causes of acute pancreatitis

A 
hyperParathyroid (hypercalcemia)
Alcohol
Neoplasm
Cholelithiasis
Rx (drugs)
ERCP
Abdominal surgery
hyperTriglyceridemia
Infection (mumps)
Trauma
Idiopathic
Scorpion bite
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2
Q

Ranson Criteria on admission

A 
increased mortality from pancreatitis (GA LAW)
Glucose > 200
AST > 250
LDH > 350
Age > 55
WBC > 16000
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3
Q

Ranson Criteria during initial 48 h after admission

A 
Increased mortality from pancreatitis (Calvin & HOBBS_
Ca < 8
Hct dec > 10%
O2 (PaO2) < 60
BUN incr >5
Base deficit > 4
Sequestration of fluid > 6 L
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4
Q

Whipple triad

A

Seen with insulinoma

  • sx of hypoglycemia while fasting
  • hypoglycemia
  • improvement of sx with carb load
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5
Q

Charcot triad

A

fever, jaundice, RUQ pain

*cholangitis

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6
Q

biopsy of liver with Reye syndrome

A

microvesicular steatosis

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7
Q

Pathogenesis of spider angiomas and palmar erythema in a patient with alcoholic cirrhosis

A

hyperestrinism - impaired hepatic metabolism of circulating estrogens
- estrogens affect vascular wall dilation

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8
Q

Osmotic vs. secretory diarrhea

A

Osmotic: elevated osmotic gap
Secretory: reduced osmotic gap, occurs while fasting or sleeping
SOG = plasma os - 2 x (stool Na + stool K)

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9
Q

9 year old with abdominal pain and difficulty swallowing that doesn’t respond to acid suppression. Patient has eczematous patches on skin. Endoscopy shows circular rings and thickened, linear furrowing of the esophagus.

A

eosinophilic esophagitis (>15 eosinophils per HPF)

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10
Q

Upper GI bleed management

A 
volume resuscitation
prophylactic antibiotics (ceftriaxone) - for cirrhotic patients
somatostatin analogues (octreotide) - prevent vasodilation
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11
Q

22 year old presents with resting tremor, muscle rigidity, clumsy gait, slurred speech, drooling, transaminitis, increased alk phos and bilirubin.

A

Wilson disease

  • test patient for low ceruloplasmin and slit lamp exam for Kayser-Fleischer rings
  • tx: trientine or penacillamine
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12
Q

Female with worsening watery diarrhea, muscle weakness/cramps, hypokalemia, low BP, increased pulse. Mass detected in tail of pancreas

A

VIPoma - rare tumor of pancreatic cells

  • VIP binds to intestinal epithelial cells to increase fluid and electrolyte secretion in the intestinal lumen
  • common mets to liver
  • tx: fluids, octreotide, possible hepatic resection
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13
Q

Complications of PBC

A

Malabsorption, fat-soluble vitamin deficiencies
Metabolic bone diseases (osteoporosis, osteomalacia)
Hepatocellular carcinoma

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14
Q

Most common cause of duodenal ulcers

A

H. pylori

tx: amoxicillin, clarithromycin and PPI

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15
Q

Rocking a patient’s hips back and forth with a stethoscope on the abdomen diagnoses

A

gastric outlet obstruction (succussion splash)

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16
Q

Pt with Chrons develops kidney stones due to increased absorption of

A

oxalate

- with fat malabsorption, calcium binds up fat leaving oxalate unbound and free to be absorbed in the bloodstream

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17
Q

Risk factors for C diff

A

Abx
Hospitalization
PPI

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18
Q

50 year old male with diarrhea, abdominal pain, and weight loss. Pt also has generalized LAD and skin hyperpigmentation. Small bowel biopsy shows villous atrophy with PAS-positive material in the lamina propria.

A

Whipple dz

- Tropheryma whipplei

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19
Q

Causes of pill induced esophagitis

A

tetracyclines, potassium chloride, NSAIDs, bisphosphonates

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20
Q

Pt with diabetes develops severe right knee pain with swelling. X-ray shows chondrocalcinosis and a moderate effusion. pt also has mild hepatomegaly

A

Hereditary hemochromatosis

  • get iron studies
  • pts commonly have diabetes and liver dz
21
Q

Vitamin deficiency associated with carcinoid syndrome

A

Niacin

- serotonin is synthesized from tryptophan which is also used to in the production of niacin

22
Q

Most common cause of liver mets

A

colon cancer

23
Q

75 year old male with cough and low grade fever, Has been treated for PNA twice. In the past 6 months he has had difficulty swallowing and frequently regurgitates food. Has foul-smelling breath and a fluctuant mass in the left neck

A

Zenker’s diverticulum

- get a contrast esophagram

24
Q

Pt with CLL has acute onset of abdominal pain, shock and anemia. She was in an exercise class when she had sudden onset of left-sided abdominal pain followed by syncope

A

Splenic rupture

25
Q

Pt with tender, erythematous, and palpable cord-like veins on the left arm and upper chest. She has a 15-30 year pack hx

A

Trousseau’s syndrome

  • migratory thrombophlebitis
  • most commonly assoc with pancreatic cancer
  • mucin released by tumor reacts with platelets to form platelet rich microthrombi
26
Q

tx to stimulate appetite in cancer patient

A

Progesterone analogue (or corticosteroids)

27
Q

Elevated AFP with blastic and lytic lesions of the spine

A

Primary testicular or hepatocellular carcinoma

28
Q

Hypotension with massive, acute increase in liver enzymes

A

ischemic hepatic injury

29
Q

Colonoscopy findings in a patient with laxative abuse

A

dark brown discoloration with pale patches of lymph follicles

30
Q

Tests for lactose intolerance

A

Positive hydrogen breath test
reduced stool pH
increased stool osmotic gap

31
Q

Young man with intermittent dysphagia with pork, chicken and steak. No issues with water. Episodes are increasing in frequency.

A

Eosiniphilic esophagitis

- dietary therapy, PPIs, topical glucocorticoids

32
Q

Bisexual man with hx of chronic constipation has tender, fluctuant, erythematous perianal mass with fever and worsening pain

A

Perianal abscess

33
Q

Colonoscopy for IBD

A

8-10 years after dx then repeat every 1-3 years

34
Q

B1 (thiamine) def

A

Beriberi (peripheral neuropathy and heart failure)

Wernicke-Korsakoff

35
Q

B2 (riboflavin) def

A

Angular chelosis, stomatitis, glossitis.
Normocytic anemia
Seborrheic dermatitis

36
Q

B3 (niacin) deficiency

A

Pellagra (dermatitis, diarrhea, delusions/dementia, glossitis)

37
Q

B6 (pyridoxine) deficiency

A

Chelosis, stomatitis, glossitis

irritability, confusion, depression

38
Q

B9 (folate, folic acid) def

A

megaloblastic anemia

NTDs

39
Q

B12 (cobalamin) def

A

megaloblastic anemia

neuro deficits

40
Q

vit C def

A

Scurvy (punctate hemorrhage, gingivitis, corkscrew hair)

41
Q

Signs of bowel obstruction with hypocalcemia and hypokalemia

A

Pseudo-obstruction

Ogilvie syndrome

42
Q

Budd-Chiari syndrome

A
  • hepatic venous outflow obstruction
  • caused by occlusion of the hepatic veins, adjacent inferior vena cava, or both; this leads to hepatic ischemia and congestion
  • ascites, jaundice, variceal bleeding, and hepatomegaly
  • liver failure with no obvious cause
43
Q

Electrolytes in refeeding syndrome

A

hypophosphatemia, hypokalemia, hypomagnesemia

44
Q

pellagra

A

Niacin deficiency

- diarrhea, dermatitis, depression, dementia, distraction, death

45
Q

Follow up for patients with liver cirrhosis

A

abdominal ultrasound every 6 months to evaluate for HCC

46
Q

Pt with anion gap metabolic acidosis and abdominal pain, vomiting, diarrhea, hematemesis, melena

A

acute iron poisoning

47
Q

Pt undergoes small bowel resection for chrons disease. He is very sedentary and develops generalized bone pain after surgery. X- rays of femoral neck show pseudofractures and x-raysof lumbar spine show decreasedbone mineral density

A

osteomalacia due to vitamin d def

- high pth, low phos, low calcium

48
Q

metaclopramide and prochlorperazine

A

antiemetics - dopamine antagonists

- can cause extrapyramidal SE dystonia, akathisia and parkinsonism

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