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Flashcards in GI Deck (151):
1

Pt presents with sudden onset severe, diffuse abd pain. Exam: peritoneal signs, AXR reveals free air under diaphragm. Management?

Emergent laparatomy to repair perforated viscus

2

Most likely cause of acute lower GI bleed in pts > 40

Diverticulosis

3

Dx modality used when US equivocal for cholecystitis

HIDA

4

Risk factors cholithiasis

Fat
Female
Fertile
Forty
Flatulent

5

Inspiratory arrest during palpation of RUQ

Murphys' acute cholecystitis

6

Most common cause SBO in pts with no Hx abd surg

Hernia

7

Most common cause SBO in pts with Hx abd surg

Adhesions

8

Diarrhea bug: most common
Tx

Campylobacter
Erythromycin

9

Diarrhea bug: recent abx

C diff

10

Diarrhea bug: camping

Giardia

11

Diarrhea bug: Traveler's

ETEC

12

Diarrhea bug: Church picnics/mayo -room temp food
-Mechanism of infection

S aureus

Preformed toxin

13

Diarrhea bug: Uncooked hamburgers
Tx

E coli O157: H7
Abx may worsen due to toxin release as bugs die so hydrate

14

Diarrhea bug: fried rice

Bacillus cereus

15

Diarrhea bug: poulty/eggs

Salmonella
Campy - 2nd most common

16

Diarrhea bug: raw seafood

Vibrio cholerae (COPIOUS WATERY DIARRHEA), HAV

17

Diarrhea bug: AIDS

Isospora
Crypotosporidium
MAC

18

Diarrhea bug: Pseudoappendicitis

Yersinia

19

25 yo Jewish man presents with pain and watery diarrhea after meals, Exam shows fistulas between bowel and skin and nodular lesions on tibias

Crohns

20

Inflammatory disease of colon with inc risk colon CA

UC

21

Extraintestinal manifestations of IBD

Uveitis
Ankylosing spondylltis
Pyoderma gangrenosum
Erythema nodosum
Primary sclerosing cholangitis

22

Tx IBD

5ASA and steroids during exacerbation

23

Difference Mallory Weiss vs Boerhaave

Malloary: superficial in mucosa
Boerhaave: full thickness rupture

24

Charcot's triad

RUQ pain
Jaundice
Fever/chills

--Signs of ascending cholangitis

25

Reynold's pentad

Charcot's triad +
Shock
Mental status change

--Signs of suppurative ascending cholangitis

26

Medical Tx hepatic encephalopathy

dec protein intake
Lactulose
Rifaximin

27

First step management acute GI bleed

ABC

28

4 yo with oliguria, petechiae, jaundice after illness with bloody diarrhea. Dx and cause

HUS 2/2 E coli O157: H7

29

Post HBV exposure Tx

HBV IVIG

30

Classic causes of drug induced hepatitis

TB meds - RIP
Acetaminophen
Tetracyclines

31

40 yo obese woman with elevated ALP and bilirubin, pruritis, dark urine, clay colored stools

Biliary tract obstruction

32

Hernia with highest risk of incarceration -- indirect, direct, or femoral

Femoral

33

50 yo man with Hx alcohol abuse presents with boring epigastric pain that radiates to back and relived by sitting forward. Tx?

Confirm Dx acute pancreatitis with elevated amylase and lipase
NPO, IVF, O2, analgesics, time

34

Common viral causes of gastroenteritis

Norwalk
Coxsackie A1
Echovirus
ADenovirus
Rotavirus in kids

35

Bloody diarrhea

Campylobacter
C diff (can also be watery)
EHEC - 0157: H7
Salmonella
Shigella- really bad
Yersinia
Entamoeba histolytica

36

Honey, home canning bug
Flaccid paralysis
Tx?

C botulinum
Tx: Botulism antitoxin

37

Gray pseudomembranes on colonic mucosa
Tx

C diff

Tx: metronidazole or oral vanc

38

Overcrowding, food or water
Tx

Shigella
Cipro or TMP-SMX if severe

39

Oysters, watery diarrhea within 24 hrs of eating

Vibrio parahemolyticus

40

Pork of fresh produce
RLQ pain

Yersinia enterocolitica

41

Cysts and trophozoites in stool
Tx

Giardia (camping) Entamoeba (poor sanitation
Metronidazole, Paramomycin (Enamoeba only)

42

Acid fast stain of stool shows parasites
Tx

Cryptosporidium

Nitazoxanide

43

Undercooked pork, myalgias, periorbital edema, eosinophilia
Tx

Taenia spiralis
Albendazole, mebendazole if bad

44

Undercooked pork, CNS Sx
Tx

Taenia solium
Praziquantel
Albendazole + steroids if CNS Sx

45

Hepatitis- fecal oral, usu shellfish; self limited disease, vaccine available for travel
Type of RNA/DNA

Hep A
Picornavirus - ssRNA

46

Water, fecal oral route; high maternal mortality in pregnant
Type of RNA/DNA

Hep E
Calcivirus - ssRNA

47

Spread via blood, sexual contact
Complication is chronic hepatitis
Type of virus
Tx

Hep C
Flavivirus- ssRNA
IFN alpha or ribavirin

48

Spread via blood, sexual contact
Risk of hepatocellular carcinoma, fulminant hepatitis, chronic hepatitis/cirrhosis
Type of virus
Tx

Hep B
IFN alpha or antivirals like lamivudine, adefovir, entecavir
Vaccine available
Hepadnavirus: ds DNA

49

Requires coexistent Hep B infection
Risk of severe hepatitis/cirrhosis
Type of virus

Hep D
Delta agent - incomplete ssRNA
Tx with Hep B vaccine

50

HBsAg - surface: neg
HBeAg: neg
Anti-HBs (Ab): pos
Anti-HBc (Ab to core): neg

Vaccinated

51

HBsAg - surface: neg
HBeAg : neg
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): Positive IgM

Acute infection window 12-20 wks after exposure

52

HBsAg - surface: Positive
HBeAg : neg
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): positive IgG

Chronic infection with leesser viral replication - good prognosis

53

HBsAg - surface: positive
HBeAg : positive
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): Positive IgM

Acute infection 4-12 wks postexposure

54

HBsAg - surface: positive
HBeAg : positive
Anti-HBs (Ab): neg
Anti-HBc (Ab to core): pos IgG

Chronic infection with active viral replication

55

HBsAg - surface: neg
HBeAg : neg
Anti-HBs (Ab): Positive
Anti-HBc (Ab to core): Positive IgG

Previous infection - recovered

56

Mg vs Al

Mg: diarrhea
Al: constipation

57

H2 antagonists
Examples
mechanisms

"tidine"
Reversibly block H2 to inhibit gastric acid secretion
Cimetidine may cause gynecomastia and impotence

58

PPI
Examples
MEchanism

"prazole"
Irreversibly block parietal cell H/K ATPase to block gastric acid secretion

59

Most common cause diarrhea adult vs kids

Adult: lactose intolerance
Kids: rotavirus

60

Type A vs Type B chronic gastritis

A: fundus, autoAB parietal cells causing pernicious anemia, dec gastrin and gastric acid
B: antrum, H pylori, inc gasric acid

61

PUD: gastric vs duodenal

Food causes Gain of pain in Gastric; Decreases pain with duodenal

62

Curling vs Cushing ulcer

Curling- burn pt
Cushing- TBI

63

Why must stop PPI before gastrin testing?

Inhibits gastrin release

64

Zollinger Ellison - where, assoc

Pancreas or duodenum
MEN I

65

Virchow node

left supraclavicular LN gastric cancer

66

Sister May Joseph node

periumbilical gastric cancer

67

Krukenberg tumor

Mets to ovary

68

Weight loss, bloating, diarrhea, steatorrhea, glossitis, dermatitis,, edema

Malabsorption

69

Celiac vs tropic

Celiac responds to removal of gluten

70

Cause of Whipple diase

Tropheryma whippelii

71

How to determine osmotic gap

290-2 (Na+K)
>125- osmotic diarrhea
<50 secretory

72

Continuous disease, bloody diarrhea, lead pie on barium enema, + pANCA

UC

73

Entire GI tract with skip lesions, entire bowel wall, perianal fissure and fistulas

Crohns

74

Flushing, diarrhea, bronchoconstriction, TV or PV disease

Carcinoid

75

Where carcinoid tumors

Bronchopulm tree
Ileum
Rectum
Appendix

76

Dx carcinoid

Lab: inc 5HIAA in urine
Rad: Indium - 111 scintography to find tumors

77

Mets colon CA

lung an dliver

78

Hundreds of polyps in colon, near certain development of malignant neoplasm, prophy with subtotal colectomy

FAP- familial adenomatous polyposis

79

Multiple genetic mutations, cancer from normal appearing mucosa, neoplasms tend to form in proximal colon

HNPCC

80

Similar to FAP + bone and soft tissue tumors

Gardner

81

Polyps are hamartomas with low risk of malignancy, mucocutaneous pigmentation of mouth, hands, genitals

Peutz-Jeghers

82

Many colonic adneomas with malignant potenential, comorbid CNS tumors

Turcot

83

Polyps of colon, small bowel and stomach that are frequently source of GI bleding; increased risk of malignancy later in life

Juvenile polyposis

84

Ranson criteria on admission - mortality from acute pancreatitis

GA LAW
Glc>200
AST>250
LDH>350
Age>55
WBC>1600

85

CEA and CA 19-9

Pancreatic cancer

86

Whipple procedure- what removed

HEad of pancreas
Distal stomach
COmmon bile duct
GB
Proximal jejunum
Duodenum

87

Complication pancreatic cancer

Trousseau - migratory thrombophlebitis

88

Whipple triad

Sx hypoglycemia while fasting
Hypoglyemia
Improvement with card load

DO WORKUP FOR INSULINOMA

89

Labs insulinoma

Increased fasting insulin and increased C peptide

90

Endocrine pancreatic cancer usually malignant

Glucagonoma

91

Watery diarrhea- endocrine tumor

VIPoma

92

Migrator necrolytic erythema

Glucogonoma

93

Charcot triad
Next step?

RUQ pain
Jaundice
Fever

Suspect cholangitis and do US or HIDA

94

Calcified GB may mean

Chronic cholecystitis
10-30% of time is cancer

95

Primary sclerosing cholangitis vs primary biliary cirrhosis

PSC: male, non antimito Ab, possible + pANCA, ERCP shows pearls on a string (stricturing and irregularity of ducts)

PBS: female, + antimito Ab and ANA; ERCP nothing exciting

96

Prehepatic vs posthepatic vs intrahepatic effect on bili

Pre: inc indirect
Post: inc direct
Intra: both or either

97

Gilbert vs Crigler Najjar I

Gilbert: jaundice with exercise, stress, fasting; ind bili 5, CNS 2/2 kernicterus

Crig Naj II like gilbert- Tx phenobarb to increase glucoronosyltransferase

98

Paracentesis of ascites vs bacterial peritonitis

Ascities: protein 250, protein >1m glc normal serum LDH

99

Paracentesis shows high albumin and LDH equal to 60% serum LDH...suspect

Neoplasm

100

Tx Wilson disease

Trientine or penicillamine

101

Alpha 1 antitrypsin findings

Liver cirrhosis and pablobular emphysema with obstructive PFT pattern

102

Liver + OCP

benign neiplasm

103

Biopsy of liver CI??

Hypervascular organ - risk hemorrhage

104

Liver mets come from

Breast
Colon
Lung

More common than primary

105

Paraneoplastic syndromes with hepatoma

Hypoglc
Excesive RBC
Refractory watery diarrhea
HyperCa
Variable skin lesions

106

Hepatitis that leads to hepatoma
Weird ither things that lead to hepatoma

HBV or HCV
Aflatoxin from Aspergillus
Schistosomiasis

107

String sign barium swallow, olive sized mass on palpation, projectile emesis.
Labs?

Pyloric stenosis

Dec Cl and K, metabolic alkalosis

108

Billous vomiting, hematochezia, air in bowel wall
Labs

Necrotizing enterocolitis

Metabolic acidosis with dec Na

109

Biopsy show no ganglia in bowel

Hirschsprung

110

Currant jelly stool, sausage like abdominal mass

Intussusception

111

Rule of 2 Meckel

2% population
M 2x more than F
2 ft ileocecal valve
Sx <2 yrs
2 types ectopic - pancreatic or gastric

112

Kernicterus is when bili deposits where

Basal ganglia
Hippocampus

113

Findings that would indicate nonphysiological cause for neonatal jaundice

Jaundice within first 24 hrs of life
Total bili > 15
Dir bili >2

114

FTT- what percentile

<3

115

Esophageal webs, Fe def anemia, glossitis

Plummer Vinson

116

Positive Tzanck

HSV

117

Oral ulcers, biopsy shows intranuclear and intracytoplasmic inclusions, retinitis, colitis

CMV

118

Pts with GERD should avoid

Caffeine
Mints
EtOH
Onions
Garlic
Chocholate
Nicotine

119

Signet ring cells on biopsy

Gastric cancer - diffuse type

120

MALT

Lymphoma 2/2 H pylori
Can Tx with abx

121

Flask shaped ulcers, water in developing country
Tx

Entamoeba histolytica

Metronidazole

122

Watery diarrhea causes

Vibrio
Rotavirus
ETEC
Cryptosporidium
Giardia

123

Gallstone ileus 0how

Gallstone erodes through intestinal wall into lumen and lodges at ileocecal valve

124

Pt with hx carcinoid tumor presents with symmetric dry hyperpigmented skin lesions, persistent diarrhea, irritable??

Pellagra- niacin (B6) def 2/2 carcinoid
Tryptophan is precursor to both 5HT and Niacin - tumor takes tryptophan

125

4 D pellagra

Dermatitis
Dementia
Diarrhea
Death

126

Ogilvie syndrome

Pseudo-obstruction of large bowel

127

S bovis...check for

colon cancer

128

Risk colon cancer

Increased age
FAP, HNPCC
FH
UC>>Crohns
Polyps: villous>tubular, sessile>>pedunculated
High fat and low fiber

129

HbSAg - what does it mean

Continued presence indicates carrier state

130

HBsAb - what does it mean

Indicated immunity to HBV

131

HBcAb - what does it mean

IgM + during window period
IgG indicator of prior or current infection

132

HBeAg = what does it mean

Indicator of transmissibility - BEware

133

Bacterial cause diarrhea: GBS, HUS, TTP

Campylobacter

134

Triad Reye syndrome

Encephalopathy
Fatty liver degen
Transaminase elevation

2/2 ASA in kids = mito damage

135

No risks for liver diase, no lab marker for hepatitis, liver enzymes >1000, + anti-smooth mm or ANA

Idiopathic AI hepatitis

136

Coagulopathy caused by cirrhosis - Tx

FFP
VIt K will not work

137

Hemochromatosis affects what organs

Liver
Heart
Skin
Pancreas
Joints

138

Bacterial cause diarrhea: GBS, HUS, TTP

Campylobacter

139

Serum ascites albumin graduent - how to determine

= serum albumin - ascites albumin

140

SAAG >1.1 vs <1.1

>1.1: RELATED TO PORTAL HTN
-Presinusoidal: splenic or portal v thrombosis, schstosomiasis
-Sinusoidal: Cirrhosis
-Postsinusoidal: RHF, constrictive pericarditis, Budd Chiari

<1.1: NOT RELATED TO PORTAL HTN
-Nephrotic
-TB
-Peritoneal carcinomatosis (ovarian cancer)

141

Acute prerenal failur ein setting of advanced cirrhosis
UNa <10

Hepatorenal syndrome

142

Coagulopathy caused by cirrhosis - Tx

FFP
VIt K will not work

143

NASH association

IR
Metabolic syndrome`

144

Triad Reye syndrome

Encephalopathy
Fatty liver degen
Transaminase elevation

2/2 ASA in kids = mito damage

145

No risks for liver diase, no lab marker for hepatitis, liver enzymes >1000, + anti-smooth mm or ANA

Idiopathic AI hepatitis

146

Bronze diabetes

Hemochromatosis

147

Liver disease + CNS or psych manifestation
Kayser-Flsecher rings

Think Wilson disease

Copper in lentiform nucleus AKA hepatolenticular degeneration

148

Liver disease results in prolonged PTT or PT

PT

149

Ranson 48 hrs later

Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
Hematocrit fall > 10%
Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
Base deficit (negative base excess) > 4 mEq/L
Sequestration of fluids > 6 L

150

Tx PUD w/ H pylori

Omeprazole
Amoxicillin (metro if allergic)
Clarithromycin

151

Toxic megacolon criteria

3 of these
Fever>38C
HR>120 bpm
Neutrophilic leukocytosis>10500
Anemia

At least one of the following:
V depletion
Altered sensorium
Electrolyte changes
Hypotension