GI Flashcards
(210 cards)
1
Q
UC vs CD: Involves the rectum
A
UC
2
Q
UC vs CD: Rectal sparing
A
CD
3
Q
UC vs CD: Bimodal age of onset
A
UC
4
Q
Ethinicity least affected by UC
A
Asians
5
Q
Male to female ratio of UC and CD
A
Approximately equal
6
Q
Effect of smoking on UC
A
May prevent disease
7
Q
Effect of appendectomy on UC
A
Protective
8
Q
UC vs CD: Pseudopolyps
A
UC
9
Q
UC vs CD: Toxic megacolon
A
UC
10
Q
Characteristic finding in UC described as villous atrophy and crypt regeneration with increased inflammation
A
Backwash ileitis
11
Q
Criteria for IBS
A
Change in bowel habits lasting for 6 months without identifiable cause
12
Q
Type of diarrhea seen in UC
A
Nocturnal
13
Q
Important features of severe UC
A
1) Fever
2) Elevated ESR
3) Ulcerations
14
Q
UC endoscopically described as fine granularity
A
Mild UC
15
Q
UC endoscopically desrcibed as having coarse granularity with no ulcerations
A
Moderate UC
16
Q
Complications of UC
A
1) Massive haemorrhage
2) Toxic megacolon
3) Perforation
4) Strictures
17
Q
Segment of colon affected in toxic megacolon of UC
A
Transverse or right colon
18
Q
Diameter of toxic megacolon
A
> 6cm
19
Q
Most dangerous complication of UC
A
Perforation
20
Q
Perforation in UC is most commonly due to
A
Megacolon
21
Q
Finding in UC associated with HIV infection
A
Proctitis
22
Q
T/F A colonic stricture is always presumed to be malignant unless proven otherwise
A
T
23
Q
Type of polyps in UC that increases the risk for cancer
A
Post-inflammatory pseudopolyps
24
Q
Extrainstestinal manifestations of UC
A
1) Erythema nodosum
2) Pyoderma gangrenosum
3) Ankylosing spondylitis
4) Anterior uveitis/iritis
5) Primary sclerosing cholangitis
25
UC vs CD: Abdominal mass
CD
26
UC vs CD: Fistulas
CD
27
UC vs CD: Response to antibiotics
CD
28
UC vs CD: Recurrence after surgery
CD
29
UC vs CD: ANCA-positive
UC
30
UC vs CD: Cobblestoning
CD
31
UC vs CD: Granuloma on biopsy
CD
32
UC vs CD: Entire GIT
CD
33
Highly selective marker for intestinal inflammation
Fecal lactoferrin
34
Earliest radiologic change in UC
Fine mucosal granularity
35
Ulcers seen in UC
Collar-button ulcers
36
UC vs CD: Increased pre sacral and perirectal fat
UC
37
Pharmacologic treatment for both CD and UC
Sulfasalazine
38
UC vs CD: Risk for colon CA
Both
39
Most common site of CD
Ileocecal area
40
UC vs CD: Skip leasions
CD
41
Earliest lesion seen in CD
Aphthous ulcer
42
Hallmark of CD
Focal transmural inflammatory process
43
Pathognomonic of CD
Creeping fat or fat wrapping
44
Histologic hallmark of CD
Noncaseating granuloma
45
Histologic feature that differentiates Tb from CD
Caseation
46
First line test for CD
CT enterography
47
Seen in radiograph of CD
String sign
48
UC vs CD: ASCA +
CD
49
T/F: Colon CA prophylaxis is an indication for surgery in CD
T
50
Surgery of choice for CD
Ileal pouch anal anastomosis (IPAA)
51
Most frequent complication of IPAA
Pouchitis
52
T/F Acute pancreatitis is reversible
T
53
Leading cause of acute pancreatitis
Gallstones
54
2nd most common cause of acute pancreatitis
Alcohol
55
Enzyme released in acute pancreatitis: Responsible for necrosis of fat
Lipase and phospholipase
56
Enzyme released in acute pancreatitis: Responsible for destruction of pancreatic parenchyma
Proteases
57
Enzyme released in acute pancreatitis: Responsible for destruction of blood vessels and subsequent interstitial hemorrhage
Elastase
58
Acute pancreatitis occurs in 5-20% of patients following this procedure
ERCP
59
Blue discoloration in the periumbilical region seen in acute pancreatitis
Cullen's sign
60
T/F: Fever in acute pancreatitis is high grade
F
61
Lung finding in acute pancreatitis
Basilar rales
62
Cardinal symptom of acute pancreatitis
Abdominal pain
63
Basilar rales in acute pancreatitis is most commonly appreciated on which lung
Left
64
Blue-red-purple or green-brown discolouration of flanks seen in acute pancreatitis
Grey-Turner sign
65
Cullen's sign is due to
Hemoperitoneum
66
Grey Turner sign is due to
Catabolism of hemoglobin
67
Acute necrotizing vs hemorrhagic pancreatitis: More severe
Acute necrotizing
68
Acute necrotizing vs hemorrhagic pancreatitis: Most severe
Hemorrhagic
69
Acute necrotizing vs hemorrhagic pancreatitis: Red-black hemorrhage and chalky fat necrosis
Acute necrotizing
70
Acute necrotizing vs hemorrhagic pancreatitis: Extensive parenchymal necrosis accompanied by dramatic hemorrhage within substance of gland
Hemorrhagic
71
Majority of islets of Langerhans are found on which part of the pancreas
Tail
72
Majority of pancreatic CA are found on which part of pancreas
Head
73
Insulinomas and glucagonomas are most frequently found on which part of the pancreas
Tail
74
Percentage of cells that must be destroyed to cause DM
>70%
75
Earliest enzyme that elevates in acute pancreatitis
Amylase
76
Most specific enzyme for acute pancreatitis
Lipase
77
Amylase levels typically return to normal levels after ___ of acute pancreatitis
48-72h
78
Complications of chronic pancreatitis (2)
1) Pancreatic pseudocyts
| 2) Malabsorption
79
Endocrine vs exocrine pancreas: Destroyed in chronic pancreatitis
Both
80
Most common cause of chronic pancreatitis in adults
Long-term alcohol abuse
81
Most common cause of chronic pancreatitis in children
Cystic fibrosis
82
Diagnostic test for chronic pancreatitis with the best sensitivity and specificity
Secretin
83
Pancreatic grading: Normal pancreas
Grade A
84
Pancreatic grading: Focal or diffuse enlargement, irregular contour, in homogenous enhancement
Grade B
85
Pancreatic grading: Peripancreatic inflammation
Grade C
86
Pancreatic grading: Intra- or extra pancreatic fluid collections
Grade D
87
Pancreatic grading: 2 or more large collections or gas in the pancreas or retroperitoneum
Grade E
88
Elevation in serum amylase required for diagnosis of acute pancreatitis
3-fold or greater
89
Diagnosis of acute pancreatitis requires 2 of the following
1) Typical abdominal pain
2) 3-fold or greater elevation in serum amylase
3) Elevated serum lipase
4) Confirmatory cross-sectional abdominal imaging
90
Criteria for severity of acute pancreatitis
1) At least 1 organ failure
2) GI bleeding >500mL/24h
3) Local complication
91
Components of BISAP score
1) BUN >25
2) Impaired mental status
3) SIRS
4) Age >60
5) Pleural effusion on radiography
92
Presence of ___ of BISAP factors is associated with substantially increased risk for in-hospital mortality
3 or more
93
Risk factors for severity of acute pancreatitis
1) Age >60
2) BMI >30
3) Comorbid disease
94
Markers of severity within 24 hours of acute pancreatitis
1) SIRS
2) Hct >44%
3) BISAP
4) Organ failure
95
Signs of organ failure in acute pancreatitis
1) CV: SBP less than 90, HR > 130
2) PaO2 less than 60 mmHg
3) Serum crea > 2 mg/dL
96
Markers of severity during hospitalization
1) Persistent organ failure
2) Pancreatic necrosis
3) Hospital-acquired infection
97
T/F Most patients with acute pancreatitis have self-limited disease
T
98
Ligament of Treitz is aka (2)
1) Hepatoduodenal ligament
| 2) Suspensory ligament of duodenum
99
Most common site of duodenal ulcer
First portion, within 3 cm of pylorus
100
Duodenal vs gastric ulcer: Sharply demarcated
Duodenal
101
Most common vessel eroded in duodenal ulcer
Gastroduodenal artery
102
Most common site for benign gastric ulcer
Distal to junction of antrum and gastric secretory mucosa
103
Longitudinal esophageal tears
Mallory-Weiss tears
104
Most common location of Mallory Weiss tears
Near GEJ
105
Most common risk factor for Mallory Weiss tears
Alcoholism
106
Management for active bleeding
Endoscopic therapy
107
Complication of duodenal ulcer
Pancreatitis
108
Complication of gastric ulcer
Penetration into left hepatic lobe
109
Type of perforation in which ulcer bed tunnels into adjacent organ
Penetration
110
Most common complication of PUD
Bleeding
111
2nd most common complication of PUD
Perforation
112
T/F Gastric perforation may be managed non-surgically
F
113
Surgical procedure done to repair gastric perforation
Graham omental patch
114
DU vs GU: Exacerbated by fasting, improved with meals
DU
115
Most common cause of death in PUD
Decompensation from underlying illness
116
Independent predictors of rebleeding and death in patients hospitalized with UGIB
1) Increasing age
2) Comorbidities
3) Hemodynamic compromise
117
Most common cause of UGIB
Ulcers
118
Melena indicates that blood has been in the GIT for at least
14h
119
Melena indicates that blood has been in the GIT for as long as
3-5 days
120
UGIB vs LGIB: Hematochezia with hemodynamic instability
UGIB
121
UGIB vs LGIB: Hematochezia with dropping Hgb
UGIB
122
UGIB vs LGIB: Hyperactive bowel sounds
UGIB
123
UGIB vs LGIB: Elevated BUN
UGIB
124
Tachycardia and hypotension represents blood loss of ___%
20
125
T/F: NGT aspirate is always bloody in UGIB
F
126
Most common causes of small intestinal bleeding in adults (3)
1) Vascular ectasia
2) Tumor
3) NSAID-induced erosions
127
Most common cause of significant LGIB in children
Meckel diverticulum
128
Characteristics of diverticular bleeding
1) Abrupt
2) Painless
3) Sometimes massive
4) Often from the right colon
129
T/F Diverticular bleeding is characterized by minor and occult bleeding
F
130
When fall in hgb is expected with acute GI bleeding
Up to 72h
131
Procedure of choice for diagnosis of UGIB
Endoscopy
132
High-risk endoscopic findings
1) Varices
2) Active bleeding vessel
3) Visible vessel
133
Low-risk lesions
1) Clean-based ulcer
2) Non-bleeding Mallory-Weiss tears
3) Erosive or hemorrhagic gastropathy
134
Colon CA screening
1) 25 y/o if with family member with HNPCC by colonoscopy
2) 40 y/o if with 2 2nd degree relatives with colorectal CA by FOBT
2) 50 y/o if with average risk by FOBT
3) 60 y/o if with 1st degree relative with colorectal CA
135
Refers to persistent or recurrent GI bleeding for which no source has been identified by routine endoscopic and contrast x-ray studies
Obscure GI bleeding
136
Initial test for massive obscure GI bleeding
Angiography
137
Diagnostic modality for Meckel's diverticulum especially in young patients
99mTc-pertechnetate scintigraphy
138
Most episodes of recurrent bleeding in PUD occur within
3 days
139
Therapeutic modality that decreases high risk ulcer characteristics/active bleeding if administered at presentation
PPI
140
T/F Mallory-Weiss tears stop spontaneously
T
141
Endoscopic therapy of choice for esophageal varices
Ligation
142
Therapy recommended with cirrhosis presenting with UGIB
Antibiotic treatment (ceftriaxone)
143
Disease endoscopically visualised as sub epithelial haemorrhages and erosions
Gastritis
144
Most important risk factors for gastritis
1) NSAID
2) Alcohol
3) Stress
145
Most common primary malignancy of liver
Hepatocellular carcinoma
146
Hepatocellular carcinoma: Male vs female
M
147
Biologic toxin that can cause hepatocellular CA
Aflatoxin B1 from aspergillus
148
T/F NAFLD/NASH is a risk factor for hepatocellular CA
T
149
Regulatory element in HBV genome that is a transcriptional activator of many genes
X protein
150
Most common symptom of hepatocellular CA
Abdominal pain
151
Most common physical sign of hepatocellular CA
Hepatomegaly
152
Abdominal pain in hepatocellular CA is due to
Stretch of Glisson capsule
153
Hepatic vein thrombosis
Budd-Chiari syndrome
154
Vessel invaded by HCC in Budd-Chiari syndrome
Hepatic vein
155
Invasion of hepatic vessels by HCC
Budd-Chiari syndrome
156
Schistosomiasis: Pre- vs postsinusoidal obstruction
Pre
157
Portal htn: Pre vs postsinusoidal obstruction
Post sinusoidal obstruction
158
Most specific tumour marker for hepatocellular CA
AFP-L3
159
Tumor marker for hepatocellular CA that is induced by absence of Vitamin K
PIVKA-2
160
Mucin-producing adenoCA in the LGBP
Cholangiocarcinoma
161
T/F CholangioCA has the propensity for early invasion of vascular channels like hepatocellular CA
T
162
Organisms associated with development of cholangioCA
3C's Cholangiocarcinoma
1) Chlonorchis sinensis (Chinese liver fluke)
2) (Cat) Opisthorchis felineus
163
Tumor found at the bifurcation of the right and left hepatic ducts to form the common hepatic duct
Klatskin tumor
164
Syndromes associated with hepatoblastoma
1) Beckwith-Weidemann syndrome
| 2) FAP
165
Most common liver tumor of childhood
Hepatoblastoma
166
Child Turcot Pugh classification is for
Classification of severity of liver disease
167
Classifications of hepatocellular CA under Child-Pugh
A-B-C
168
Classifications of hepatocellular CA under Child-Pugh: Earliest stage
A
169
Components under the Child-Pugh classification
1) Bilirubin
2) Albumin
3) PT INR
4) Encephalopathy
5) Ascites
170
Brain waves seen in encephalopathy
Delta waves
171
Substance used to test for the biosynthetic function of the liver in acute liver failure
Vitamin K dependent factors (PT)
172
Substance used to test for the biosynthetic function of the liver in chronic liver failure
Albumin
173
Half-life of albumin
10-14d
174
T/F Fatty liver is reversible
T
175
Induction of fibrosis in the liver occurs with activation of
Hepatic stellate cells
176
Chief worldwide cause of cirrhosis
Alcoholism
177
Gross description of alcoholic cirrhosis
Micronodular surface
178
Alcoholic cirrhosis is aka (2)
1) Blind man's disease
| 2) Laenec's cirrhosis
179
Inherited metabolic liver diseases
1) Hemochromatosis
2) Wilson's disease
3) a1 anti-trypsin deficiency
4) Cystic fibrosis
180
Reaction in which cephalosporins and metronidazole cause increased acetate production in alcoholic cirrhosis
Disulfiram reaction
181
Ethanol oxidation occurs via ADH to form
Acetaldehyde
182
Acetaldehyde is metabolized to acetate by what enzyme
Acetaldehyde dehydrogenase (ALDH)
183
Central event in the pathogenesis of alcoholic liver cirrhosis
Stellate cell activation
184
Hemolytic anemia seen in patients with alcoholic hepatitis
Zieve's syndrome
185
Most common disease transmitted by blood transfusions
Hepatitis
186
Virus responsible for hepatitis transmission in needle sharing and blood transfusion
Hepatitis C
187
Hepatitis virus associated with hepatitis in concomitant alcohol users
Hepatitis C
188
Hepatitis B vs C: Chronic hepatitis
C
189
T/F Majority of HBV infected patients develop cirrhosis
F
190
Hepatitis virus responsible for vertical transmission
B
191
T/F Most patients with primary biliary cirrhosis are symptomatic
F
192
First symptom of primary biliary cirrhosis
Pruritus
193
AST ALT ratio in primary biliary cirrhosis
2:1
194
Liver biopsy in primary biliary cirrhosis is withheld for this duration to determine residual nonreversible disease
Abstinence maintained for at least 6 months
195
Cytokine implicated in development of primary biliary cirrhosis
TNF
196
Antibodies present in about 90% of patients with primary biliary cirrhosis
Antimitochondrial antibodies (AMA)
197
Etiology of primary biliary cirrhosis
Unknown
198
Treatment of choice for decompensated primary billary cirrhosis
Liver transplantation
199
Treatment for primary biliary cirrhosis that has been shown to improve both biochemical and histologic features of disease
UDCA
200
Treatment for cirrhosis due to chronic hepatitis B
Lamivudine
201
What class of drug is Lamivudine
Reverse transcriptase inhibitor
202
Chronic cholestatic syndrome characterised by diffuse inflammation and fibrosis involving the entire biliary tree resulting in chronic cholestasis
Primary sclerosing cholangitis
203
Cause of primary sclerosing cholangitis
Unknown
204
Imaging technique of choice for evaluation of primary sclerosing cholangitis
MRI with MRCP
205
Antibody present in majority of patients with primary sclerosing cholangitis
p-ANCA
206
Treatment of choice for cirrhosis due to chronic hepatitis C (2)
1) Pegylated interferon
| 2) Ribavirin
207
Side effects of pegylated interferon and ribavirin for chronic hepatitis C
1) Leukopenia
| 2) Thrombocytopenia
208
APACHE
ICU mortality
209
Ranson
Predicts severity based on findings on admission and within 48 hours
210
Bisap
Bedside index of severity in acute pancreatitis
