GI Diagnosis Flashcards

(42 cards)

1
Q

Divertuculosis Diagnosis

A

Barium enema is diagnostic test of choice

Most often found incidentally on colonoscopy done for another reason

Abdominal Xrays are normal

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2
Q

Diagnosis of diverticulitis

A

Fever, leukocytosis and LLQ pain (no painless rectal bleeding)
CT scan with oral and IV contrast

Abdominal radiographs exclude other causes of LLQ pain

barium enema and colonoscopy are contraindicated

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3
Q

Acute mesenteric ischemia diagnosis

A

hypotension, lactic acidosis, altered mental status

Mesenteric angiography is definitive diagnosis
Plain film of abdomen to exclude other causes of abdominal pain
Thumbprininting on barium enema due to thickened edematous mucosal folds

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4
Q

chronic mesenteric ischemia diagnosis

A

Mesenteric arteriography

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5
Q

Pseudomembranous colitis diagnosis

A

C. difficile toxins in stool is diagnostic (takes 24 hours)
Flexible sigmoidoscopy is most rapid test and is diagnostic-infrequently used
Abdominal radiograph rules out toxic megacolon and peforation
Leukocytosis

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6
Q

Sigmoid and cecal volvulus diagnosis

A

Plain abdominal film
Sigmoid: bent inner tube shape (omega sign) idnicates dilated sigmoid colon
Cecal: coffee bean sign-distension of cecum and small bowel, large air fluid level in RLQ

Sigmoidoscopy: preferred for sigmoid since also therapeutic

Barium enema reveals narrowing of the colon-not used if possible strangulation

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7
Q

Diagnosis of Cirrhosis

A

Biopsy is gold standard

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8
Q

Diagnosis of portal hypertension

A

Bleeding (hematemesis, melena, hematochezia)

Paracentesis can help with diagnosis

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9
Q

Diagnosis of esophageal varices

A

Emergent upper GI endoscopy (once patient is stabilized)

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10
Q

Diagnosis of ascites

A

paracentesis:
Serum ascites albumin gradient: greater than 1.1 g/dl=portal hypertension
less than 1.1 then portal HTN is less likely

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11
Q

Diagnosis of Wilson’s disease

A

Elevated aminotransferases, impaired synthesis of coagulation factor and albumin
Decreased serum ceruloplasmin (normal ranges do not exclude diagnosis)
Livery biopsy: elevated copper concentration

If diagnosed first degree relatives must be screened as well

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12
Q

Diagnosis of hemachromatosis

A

Elevated serum iron and serum ferritin
Elevated iron saturation
Decreased TIBC
Liver biopsy required for diagnosis!

Genetic testing for chromosomal abnormalities
Screen siblings-early diagnosis improves survival

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13
Q

Pyogenic liver abscess diagnosis

A

Ultrasound or CT scan
Elevated LFTs

E.coli, klebsiella, proteus, enterococcus, and anaerobes
Patients appear quite ill

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14
Q

Diagnosis of amebic liver abscess

A

Immunoglobulin G enzyme immunoassay

LFT elevation

stool Ag test is not sensitive

Ultrasound and CT identify abscess

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15
Q

Diagnosis of budd chiari syndrome

A

hepatic venography

Serum ascites albumin gradient >1.1

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16
Q

Mild (low hundreds) vs. moderate (high hundreds to thousands) vs. severely (>10,000) elevated AST and ALT

A

Mild: chronic viral hepatitis or acute alcoholic hepatitis

moderate: acute viral hepatitis
severe: extensive hepatic necrosis (ischemia, shock, acetaminophen toxicity, severe viral hepatitis)

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17
Q

Diagnosis of cholelithiasis

A

RUQ ultrasound for stones >2 mm

CT scan and MRI are alternatives

18
Q

Diagnosis of acute cholecystitis

A

RUQ ultrasound is test of choice-thickened gallbladder wall, pericholecystic fluid, distended gallbladder, and presence of stones
CT scan as accurate but better for identifying complications (peforation, abscess, pancreatitis)
HIDA scan used if ultrasound inconclusive-gallbladder not visualized after 4 hours=positive HIDA scan and confirmation of acute cholecystitis

19
Q

Diagnosis of choledocholithiasis

A

Total and direct bilirubin are elevated and Alk-phos
Ultrasound is initial but is not sensitive
ERCP is gold standard and also therapeutic
Percutaneous transheptic cholangriography is an alternative to ERCP

20
Q

Diagnosis of cholangitis

A

RUQ, fever, jaundice, septic shock, disorientation
Initial study is ultrasound
Hyperbilirubinemia, lekuocytosis, mild elevation in serum transaminases
Cholangiography (Percutaneous transheptic cholangriography or ERCP)-not during acute phase wait until afebrile for 48 hours
PTC when duct is dialted
ERCP when duct system is normal

21
Q

Diagnosis of primary sclerosing cholangitis

A

Associated with ulcerative colitis
ERCP and PTC-multiple areas of bead-like stricturing and bead-like dilatations of itnrahepatic and extrahepatic ducts
Cholestatic LFTs

22
Q

Diagnosis of primary biliary cirrhosis

A
Cholestatic LFTs (Alk Phos)
Antimitochondrial antibodies
Confirmational: liver biopsy
Elevated cholesterol, HDL
Elevated immunoglobulin M
Abdominal US to rule out biliary obstruction
23
Q

Diagnosis of acute appendicitis

A
CT scan (Sn=98%)
ultrasound
24
Q

Acute pancreatitis diagnosis

A

Increased amylase and lipase (lipase more specific)
LFTs to identify cause
Hyperglycemia, hypoxemia and leukocytosis

Prognosis get: glucose, age (>55), LDH, AST, WBC
Calcium, hematocrit, PaO2, BUN, Base deficit, fluid sequestration

Radiograph: rules out perforation, calcifications=chronic

ultrasound: identifies cause and can follow up pseudocyst or abscesses

CT: most accurate

25
pancreatic pseudocyst diagnosis
CT scan
26
Hematemesis
Upper GI endoscopy
27
Hematochezia
Colonscopy
28
Melena
Upper GI endoscopy then colonoscopy if nothing found
29
Occult blood
Colonoscopy | Upper GI endoscopy if nothing found
30
Lower vs upper GI bleed
Nasogastric tube Bile but no blood: upper GI bleeding unlikely source distal to ligament of Trietz Bright blood or coffee grounds-upper GI bleeding Nonbloody aspirate: upper G bleeding unlikely
31
Diagnosis of achalasia
Barium swallow: birds beak, dilated esophagus proximal to the narrowing Upper GI endoscopy: rule out secondary causes of achalasia Manometry: confirms the diagnosis
32
Diffuse esophageal spasm diagnosis
Manometry: simultaneous, multiphasic, repetitie contractions that occur after swallow, normal sphincter response GI barium swallow: corkscrew esophagus
33
Esophageal hiatal hernias diagnosis
Sliding: Gastroesophageal junction above the diaphragm-GERD Paraesophageal: gastroesophageal junction does not cross the diaphragm can become strangulated and should be repaired surgically Barium Upper GI series, upper endoscopy
34
esophageal diverticula diagnosis
Barium swallow
35
Esophageal perforation diagnosis (Boerhaaves)
Water soluble contrast esophagram: gastrografin swallow is definitive CXR shows air in mediastinum
36
Peptic Ulcer Disease Diagnosis
Duodenal associated with Type O blood Gastric associated with Type A blood Treat empiricallly unless GI bleed is present Endoscopy: necessary for gastic ulcer for biopsy to rule out malignancy and can be used for H. pylori biopsy Urease breath test: convenient and can assess the results of antiobiotic therapy serum gastrin if considering Zollinger-Ellison syndrome
37
GI perforation diagnosis
CXR: free air under diaphragm CT scan most sensitive for free abdominal air
38
GI bleeding diagnosis
Stool guaiac | Upper G endoscopy (diagnostic and therapeutic)
39
Small bowel obstruction diagnosis
Deyhdration: hypocholremia (vomiting) hypokalemia, metabolic alkalosis Tachycardia, hypotension, tachypnea, altered mental status and oliguria Abdominal plain films: dilated loops of small bowel, air fluid levels proximal to pint of obstruction and minimal gas in colon Barium enema-identifies site of obstruction
40
Paralytic ileus diagnosis
Failure to pass contrast medium beyond fixed point
41
Crohn's disease diagnosis
Endoscopy: sigmoidscopy or colonoscopy with biopsy apthous ulcerrs, cobblestone apperance, pseudopolyps, pstychy skip lesions Barium enema
42
Ulcerative colitis diagnosis
Stool culutres for C. difficile, ova and parasies Fecal leukocyes Colonoscopy