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GI/Hepatology Flashcards

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1
Q

Typical sources of upper abdominal pain

A
  • gastric
  • hepatobiliary
  • pancreatic
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2
Q

Typical sources of lower abdominal pain

A
  • hindgut
  • lower small/large intestine
  • genitourinary
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3
Q

Typical sources of periumbilical abdominal pain

A
  • midgut

- pancreas

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4
Q

hematemesis =>

A

upper GI source

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5
Q

melena/maroon stools/hematochezia ==>

A

upper or lower GI source

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6
Q

Charcot’s triad (GI) + meaning

A
  • abdominal pain
  • jaundice
  • fever
  • suggests cholecystitis or ascending cholangitis
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7
Q

Peptic ulcer disease presentation

A
  • burning vs. cramping/vague pain
  • typically epigastric, but may also be LUQ/RUQ
  • radiation to back unusual, suggests alternate (pancreatitis, vascular) or penetrating PUD
  • some patients food worsens gastric ulcer, improves peptic ulcers (<50%)
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8
Q

Pancreatitis presentation

A
  • acute epigastric pain, often w/radiation to back
  • pain may decrease w/fetal or lying on side
  • (+) vomiting
  • gallstone panc => jaundice
  • hx Etoh => alcoholic
  • dx via serum lipase
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9
Q

Grey-turner sign

A
  • flank ecchymoses seen in pancreatitis

- results from retroperitoneal bleeding

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10
Q

foregut components

A 
Esophagus (distal end)
Stomach
Duodenum (proximal half)
Liver
Gallbladder
Pancreas
Spleen
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11
Q

midgut components

A 
Duodenum (distal half of 2nd part, 3rd and 4th parts)
Jejunum
Ileum
Cecum/Appendix
Ascending colon
Hepatic flexure of colon
Transverse colon (proximal two-thirds)
-supplied by superior mesenteric a./nerve plexus
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12
Q

hindgut components

A
  • distal third of the transverse colon and the splenic flexure, the descending colon, sigmoid colon and rectum
  • supplied by inferior mesenteric a./nerve plexus
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13
Q

Retroperitoneal organs

A 
P: pancreas (except tail)
U: ureters.
C: colon (ascending and descending)
K: kidneys.
E: (o)esophagus.
R: rectum.

abdominal aorta

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14
Q

cullen sign

A

-periumbilical ecchymoses associated with pancreatitis

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15
Q

radiologic eval of pancreatitis

A

US for stones

CT w/oral and IV contrast

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16
Q

RUQ pain ddx

A
  • cholecystitis
  • acute cholangitis
  • acute viral hepatitis
  • acute alcoholic hepatitis
  • gonococcal perhihepatitis
  • PNA
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17
Q

Midepigastric or periumbilical pain ddx

A
  • acute pancreatitis
  • perforating peptic ulcer
  • mesenteric ischemia
  • SBO
  • celiac
  • DKA
  • aortic dissection/rupture
  • inferior myocardial infarction
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18
Q

RLQ pain ddx

A
  • acute appendicitis
  • ectopic pregnancy; ovarian cyst; ovarian torsion
  • pelvic inflammatory disease
  • nephrolithiasis
  • pyelonephritis
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19
Q

LLQ pain ddx

A
  • acute diverticulitis

- toxic megacolon

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20
Q

dx of appendicitis

A
  • missed in 20% of cases
  • classic: periumbilical => RLQ
  • +anorexia, may be followed by N/V
  • dx of appendicitis is doubtful if N/V are first signs
  • PE: mcburney’s point (1/3 ASIS to umb), psoas sign (pain w/ext of right thigh while lying on left side; +/- rigidity
  • leukocytosis/fever = sensitive, not specific
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21
Q

SBO presentation

A
  • central abd pain + vomiting/constipation
  • hx abdominal surgey
  • abd. distension, hyperactive bowel sounds
  • abd xr: multiple dilated loops bowel + air-fluid levels
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22
Q

Causes of colonic distension

A
  • mechanical obstruction (tumors, stool)
  • toxic megacolon
  • pseudo-obstruction (ogilvie syndrome)
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23
Q

Toxic megacolon presentation

A
  • c.diff complication
  • bloody diarrhea
  • fever, tachy, abd. tenderness
  • abd xray: thumbprinting
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24
Q

Pseudo-obstruction causes/presentation

A
  • dilation of cecum/right hemi-colon w/out mechanical obstruction
  • cases: trauma, infection, cardiac disease
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25
acute diverticulitis presentation
- LLQ abdominal pain + TTP - hx of chronic consipation and intermittent low-grad abd. pain - if gaurding, rigidity, fluctuant mass ==> abscess - ==> abd CT w/oral + IV contrast`\
26
Most sens/spec imaging for evaluating flank pain
helical CT
27
Criteria used to dx IBS
- Rome criteria (sens 48%, spec 100%) | - Manning criteria (sens 60%, spec 80%)
28
Red flags in chronic abd pain
- onset after 50 - weight loss - anorexia - malnutrition - bleeding - fhx of IBD
29
Tx of IBS
- sx management - fiber @ constipation-pred - loperamide @ diarrhea-pred (after celiac excluded0 - SSRIs (const) or TCA (diarrhea)
30
cardinal signs of chronic pancreatitis (4)
- pain - DM - steatorrhea - pancreatic calculi (on CT)
31
courvoisier sign
- nontender palpable gallbladder | - sign of cancer of pancreatic head (w/jaundice)
32
Most common complication of PUD
- GI bleeding: hematemesis, melena, hematochezia | - occult bleeding presenting as iron-def anemia is less common but occurs
33
indication for upper endoscopy
pts >55yo w/unexplained epigastric abd pain AND patietns with abd pain + unexplained weight loss, GI bleeding, microcytic anemai, recurrent vomiting
34
H. pylori testing
- endoscopic: histologic assessment or rapid urease test | - nonendoscopic: serum ab, urea breath test, stool antigen (stool/breath can be used for confirmation of elimination)
35
Gastrinoma presentation
- mass of cells producing gastrin => excess acid production => "Zollinger-Ellison syndrome": - recurrent/refractory ulcers - ulcers @ distal duodenum - watery diarrhea - associated w/MEN I (hyperparathyroidism, pancreatic islet cell tumor, pituitary adenoma)
36
Management of PUD
- 4-6 weeks of PPI - stop/decrease NSAIDs - H. pylori: PPI + amoxicillin + clarithromycin OR PPI + clarithromycin + metronidazole
37
Stimulants for acid production
- gastrin - ACh - histamine
38
Hepatocellular injury ==> enzyme elevations
AST & ALT | ALT = greater specificity for liver injury (minimally produced elsewhere)
39
Cholestasis definition & dx
- cholestasis = impaired flow of bile from liver | - ==> elevated alk-phos +/- elevated bilirubin + elevated GGT, 5'-nucleotidase
40
Unconjugated (indirect) vs. conjugated (direct) hyperbilirubinemia
unconjugated (indirect) = overproduction/hemolysis or impaired conjugation (e.g. gilbert syndrome) conjugated (direct) = hepatocellular dysfxn/injury or cholestasis or inherited (Dubin-johnson, rotor syndrome)
41
Liver chemistry for acute viral hep
- AST: +++ - ALT: +++ - AlkPhos: ++ - Bili: varies - other: exposure hx, constitutional sx
42
Liver chemistry for alcoholic hepatitis
- AST: +++ - ALT: + - AlkPhos: Normal to + - Bili: varies - other: hx alcohol abuse
43
Liver chemistry for acute autoimmune hepatitis
- AST: +++ - ALT: +++ - AlkPhos: normal to + - Bili: varies - other: autoab
44
Liver chemistry for wilson dz
- AST: ++ - ALT: ++ - AlkPhos: low - Bili: + (unconj.) - other: hemolysis, neuropsych sx, renal tubular acidosis
45
Liver chemistry for alpha-1-antitrypsin/hemochromatosi dz
- AST: + - ALT: + - AlkPhos: normal to + - Bili: normal - other: @alpha1 = lung disease; @hemo=elevated ferritin
46
Liver chemistry for primary biliary cirrhosis/sclerosing cholangitis
- AST: + - ALT: + - AlkPhos: +++ - Bili: normal to ++ - other: @PBC= (+)AMA ab; @PSC=presence of IBD
47
Liver chemistry for large bile duct obstruction
- AST: ++ - ALT: ++ - AlkPhos: ++ - Bili: ++ - other: abdominal pain
48
Liver chemistry for infiltrative liver dz (eg lymphoma)
- AST: + - ALT: + - AlkPhos: +++ - Bili: normal - other: malaise, hepatomegaly
49
Liver chemistry for ischemic hep ("shock liver")
- AST: +++ - ALT: +++ - AlkPhos: normal to + - Bili: normal - other: hx hypotension, rapid resolution of studies
50
Tests for liver synthetic fxn
PT INR non-specific/insensitive test
51
Hepatocellular pattern vs. cholestatic pattern LFTs
- hepatocellular: AST/ALT >> Alk phos | - cholestatic: Alk phos >> AST/ALT
52
general symptoms of hepatitis
- n/v - abd pain - malaise - jaundice
53
Long-term risk in HBV/HCV
hepatocellular carcinoma
54
causes of non-viral hepatitis
- alcoholic - autoimmune - toxin/drug-induced - genetic causes - metabolic liver disease
55
Most common causes of acute viral hepatitis
- Hep A (50%) - may not have any classical risk factors - Hep B (33%) - may not have any classical risk factors - Hep D - Hep C NOT usually acute, typically viral
56
Serologic dx in acute HBV
- HBsAg: + - Anti-Hbc: + - Anti-Hbs: - - HBV DNA: + - HBeAg: + - Anti-HbeAg: +/-
57
Extrahepatic manifestations of hep B
- glomerulonephritis - polyarteritis nodosa - cryoglobulinemia
58
Serologic dx in inactive HBV carriers
- HBsAg: + - Anti-Hbc: + - Anti-Hbs: - - HBV DNA: - - HBeAg: - - Anti-HbeAg: +
59
Serologic dx in chronic HBV hepatitis
- HBsAg: + - Anti-Hbc: + - Anti-Hbs: - - HBV DNA: + - HBeAg: +/- - Anti-HbeAg: +/-
60
Criteria for hospitalization in acute hepatitis
- inability to maintain oral hydration | - signs/sx of liver failure
61
Common tx for chronic hep B
- interferon (contraindicated in advanced chronic dz => decompensation) - lamivudine
62
Indication for glucocorticoid tx in alcoholic hepatitis
- maddrey discriminant fucntion score ==> indicates whether improved short-term survival w/GC therapy - DF = 4.6 (PT [s] - control PT time [s]) + serum bili - DF>32 ==> candidate for prednisone
63
Antidote for tylenol toxicity
n-acetylcysteine
64
antidote for valproic acid toxicity
L-carnitine
65
symptoms of cirrhosis
- hepatocyte dysfxn ==> jaundice, coagulopathy (bleeding) - increased portal venous pressure ==> ascites, edema, SBP, bleeding esophogeal varices, hepatic encephalopathy, hypersplenism
66
Signs of jaundice
- yellowed sclera - yellowed skin - urine color changes - pruritis related to cholestasis

Internal Medicine (4 decks)

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