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Flashcards in GI Diagnosis Deck (42):
1

Divertuculosis Diagnosis

Barium enema is diagnostic test of choice

Most often found incidentally on colonoscopy done for another reason

Abdominal Xrays are normal

2

Diagnosis of diverticulitis

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

3

Acute mesenteric ischemia diagnosis

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

4

chronic mesenteric ischemia diagnosis

Mesenteric arteriography

5

Pseudomembranous colitis diagnosis

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

6

Sigmoid and cecal volvulus diagnosis

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

7

Diagnosis of Cirrhosis

Biopsy is gold standard

8

Diagnosis of portal hypertension

Bleeding (hematemesis, melena, hematochezia)
Paracentesis can help with diagnosis

9

Diagnosis of esophageal varices

Emergent upper GI endoscopy (once patient is stabilized)

10

Diagnosis of ascites

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

11

Diagnosis of Wilson's disease

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

12

Diagnosis of hemachromatosis

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

13

Pyogenic liver abscess diagnosis

Ultrasound or CT scan
Elevated LFTs

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

14

Diagnosis of amebic liver abscess

Immunoglobulin G enzyme immunoassay

LFT elevation

stool Ag test is not sensitive

Ultrasound and CT identify abscess

15

Diagnosis of budd chiari syndrome

hepatic venography
Serum ascites albumin gradient >1.1

16

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

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

17

Diagnosis of cholelithiasis

RUQ ultrasound for stones >2 mm
CT scan and MRI are alternatives

18

Diagnosis of acute cholecystitis

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

Diagnosis of choledocholithiasis

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

Diagnosis of cholangitis

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

Diagnosis of primary sclerosing cholangitis

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

Diagnosis of primary biliary cirrhosis

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

23

Diagnosis of acute appendicitis

CT scan (Sn=98%)
ultrasound

24

Acute pancreatitis diagnosis

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