GI High Yield Flashcards

1
Q

What is Achalasia

A

Loss of Auerbach’s Plexus that leads to increased LES pressure

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2
Q

Sx of Achalasia

A

Dysphagia to both solids and liquids

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3
Q

Dx of Achalasia

A

Gold Standard: Esophageal Monometry

Double Contrast Esophogram: See Birds Beak (LES narrowing)

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4
Q

Tx of Achalasia

A

Decreased LES pressure with Botulinum toxin injection

Nitrates, CCB, Pneumatic dilation

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5
Q

What is Zenker’s Diverticulum

A
Pharyngoesophageal pouch (false diverticulum, involves only the mucosa)
Located at junction of pharynx and esophagus
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6
Q

Sx of Zenker’s Diverticulum

A

Dysphagia, Regurgitation, Cough, Feeling lump in neck

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7
Q

Dx of Zenker’s Diverticulum

A

Barium Swallow

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8
Q

Tx of Zenker’s Diverticulum

A

Observation if small and asymptomatic

Diverticulectomy, Cricopharyngeal Myotomy

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9
Q

What is Eosinophilic Esophagitis

A

Allergic, Inflammatory, Esophageal Inflammation

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10
Q

Sx of Eosinophilic Esophagitis

A

Dysphagia, especially with solids

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11
Q

Dx of Eosinophilic Esophagitis

A

Endoscopy: See normal or multiple corrugated rings

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12
Q

Tx of Eosinophilic Esophagitis

A

Remove foods that incite allergic response

Topical steroids via inhaler

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13
Q

What is usually associated with Esophageal Cancer

A

Smoking, Alcohol, Exposure of esophagus to noxious stimuli

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14
Q

What location is typically affected by Esophageal Cancer

A

Upper 1/3 of esophagus

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15
Q

Who gets Esophageal Cancer

A

AA 50’s

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16
Q

Sx of Esophageal Cancer

A

Solid food dysphagia with eventual fluid dysphagia, odynophagia
Weight loss, chest pain, anorexia
Hypercalcemia in pts with squamous cells

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17
Q

Dx of Esophageal Cancer

A

Upper Endoscopy with Biopsy

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18
Q

Tx of Esophageal Cancer

A

Esophageal resection
XRT
Chemo

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19
Q

What is a Mallory-Weiss Tear

A

UGI bleeding due to longitudinal mucosal lacerations at GE junction or gastric cardia

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20
Q

Sx of Mallory-Weiss Tear

A
Retching/Vomiting
Hematemesis after alochol binge
Melena
Hematochezia
Syncope
Abdominal Pain
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21
Q

Dxy of Mallory-Weiss Tear

A

Upper endoscopy with biopsy

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22
Q

Tx of Mallory-Weiss Tear

A

Supportive if no bleeding

If bleeding, Epinephrine injections, sclerosing agent, band ligation, hemo-clipping

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23
Q

What is a Hiatal Hernia

A

Protrusion of upper portion of stomach into chest cavity due to diaphragm tear or weakness

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24
Q

What causes Esophageal Varices

A

Portal Vein Hypertension

Dilation of gastroesophageal collateral, submucosal veins

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25
Q

Sx of Esophageal Varices

A

Upper GI bleed (Hematemesis, Melena, Hematochezia)

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26
Q

Dx of Esophageal Varices

A

Upper Endoscopy: See enlarged veins, Red wale markings and cherry red spots

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27
Q

Tx of Esophageal Varices

A

Stabilize with 2 large bore IV lines and IV fluids
Endoscopic ligation
Octreotide in acute bleeds (vasoconstrictor)
Vasopressin to decrease portal venous pressure

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28
Q

What meds to you give to prevent rebleeds in esophageal varices

A

Beta Blockers: Propranolol, Nadolol
Isosorbide
Fluoroquinolones or Ceftriaxone to prevent infectious complications

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29
Q

What is Gastritis

A

Superficial inflammation/irritation of the stomach mucosa with mucosal injury

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30
Q

What causes Gastritis

A

H.Pylori
NSAIDS/ASA
Acute Stress

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31
Q

Sx of Gastritis

A

Asymptomatic

Upper GI bleed, Epigastric pain, N/V

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32
Q

What is the gold standard dx for Gastritis

A

Endoscopy

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33
Q

What else can you use to dx gastritis

A

H.Pylori testing

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34
Q

Tx for Gastritis based on H.Pylori testing

A

If H.Pylori Positive: Triple Therapy (PPI, Amoxicillin, Clarithromycin)
If H.Pylori Negative: PPI, Antacids/H2 Blockers, Sucralfate

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35
Q

What is Peptic Ulcer Disease

A

Results from decreased mucosal protective factors and increased damaging factors

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36
Q

What causes PUD

A

H.Pylori Infection, NSAIDS, Gastrinoma (Zollinger Ellison Syndrome)

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37
Q

What type of Peptic ulcer is more likely (location)

A

Duodenal is more common

More benign

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38
Q

Sx of PUD

A

Dyspepsia (epigastric pain) worse at night, radiates to back or LUQ

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39
Q

What sx accompany a Duodenal Ulcer

A

Pain before meals or 2-5 hours after meals

Pain improves after eating

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40
Q

What sx accompany a Gastric Ulcer

A

Pain during meals or 1-2 hours after meals and weight loss

Associated with cancer

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41
Q

Dx of PUD

A

Gold Standard: Endoscopy with Biopsy

Upper GI Series

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42
Q

What type of testing is done for H.Pylori (what is Gold Standard)

A

Gold Standard is Endoscopy with Biopsy
Positive Urea Breath Test (used to confirm eradication too)
H.Pylori Stool Antigen
SEriologic Antibodies (only useful to confirm present infection)

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43
Q

Tx of PUD

A

Triple Therapy for H.Pylori Eradication (PPI, Amoxicillin, Clarithromycin)
If H.Pylori Negative: PPI, H2 Blockers, Misoprostol, Antacids
Parietal Cell Vagotomy if refractory

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44
Q

What is Zollinger Ellison Syndrome

A

A Gastrinoma (Gastrin Secreting Neuroendocrine Tumor)

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45
Q

Sx of Zollinger Ellison Syndrome

A

Multiple Peptic Ulceers
Refractory Ulcers
“kissing” ulcers

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46
Q

Dx of Zollinger Ellison Syndrome

A

Increased fasting gastrin level is best screening
Secretin Test: Increased gastrin release with secretin seen in gastrinomas
Normally, gastrin release is inhibited by secretin

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47
Q

Tx of Zollinger Ellison Syndrome

A

Surgical Resection of Tumor

If METS: PPI, Surgical resection if liver involved

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48
Q

What is the most common form of Gastric Carcinoma

A

Adenocarcinoma

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49
Q

Sx of Gastric Carcinoma

A

Indeigestion, weight loss, early satiety, abdominal pain/fullness
Signs of METS: Supraclavicular LN, Umbilical LN, Ovarian Mets

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50
Q

Dx of Gastric Carcinoma

A

Upper Endoscopy with biopsy

Gastrectomy, XRT, and Chemo

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51
Q

What is Pyloric Stenosis

A

Hypertrophy and Hyperplasia of muscular layers of pylorus

Causes a functional outlet obstruction

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52
Q

Sx of Pyloric Stenosis

A

Usually in newborns, nonbilous projectile vomiting

Olive shaped nontender mobile hard pylorus

53
Q

Dx of Pyloric Stenosis

A

Ultrasound

Upper GI contrast study: See String Sign

54
Q

Tx of Pyloric Stenosis

A

Pyloromyotomy

Rehydration

55
Q

What is Cholelithiasis

A

Gallstones in Gall Bladder (not inflammatory)

90% are cholesterol

56
Q

RF for Choleleithiasis

A

5 F’s: Fat, Fertile, Female, Fair, Forty

57
Q

Sx of Cholelithiasis

A

Biliary Colic: Episodic RUQ pain, Epigastric pain that begins abruptly
Continuous in duration
Resolves slowly lasting about 30min-1hr
Precipitated by fatty foods or large meals

58
Q

Dx of Cholelithiasis

A

Ultrasound

59
Q

Tx of Cholelithiasis

A

If asymptomatic: Observe

Cholecystecomy in sx patients

60
Q

Complications of Cholelithiasis

A

Choledochlithiasis: Gallstones in biliary tree

61
Q

What is Acute Cholecystitis

A

Gall Bladder (cystic duct) obstruction by gallstone that leads to Inflammation or Infection

62
Q

What pathogen is most involved in acute cholecystitis

A

E.Coli

63
Q

Sx of Acute Cholecystitis

A

Biliary Colic
Murphy’s Sign (Acute RUQ pain/inspiratory arrest with GB palpation)
Boas Sign: Referred pain to right subscapualr area due to phrenic nerve irriation

64
Q

Dx of Acute Cholecystitis

A

Ultrasound is initial test
Labs: Increased WBC, Increased Bili, Increased ALP and LFT
Hida Scan is GOLD STANDARD

65
Q

Tx of Acute Cholecystitis

A

NPO, IVF, Abx (3rd gen Cephalosporin + Metronidazole)

Cholecystectomy within 3 days

66
Q

What is Choledocholithiasis

A

Gallbladder stones in biliary tree (common bile duct)

67
Q

Sx of Choledocholithiasis

A

Biliary Colic

Jaundice

68
Q

Tx for Choledocholithiasis

A

Stone extraction via ERCP

69
Q

What is Cholangitis

A

Biliary tree infection secondary to obstruction by gallstones

70
Q

Sx of Cholangitis

A

Charcot’s Triad: Fever/Chills, RUQ pain, Jaundice

Reynold’s Pentad: Shock plus AMS

71
Q

Dx of Cholangitis

A

ERCP

72
Q

Tx of Cholangitis

A

Penicillin + Aminoglycosides (Streptomycin, Gentamycin)

73
Q

What forms of Hepatitis are spread by Fecal-Oral

A

Hepatitis A and Hepatitis E

74
Q

What forms of Hepatitis are spread by Blood, Sex, Drugs

A

Hepatitis B, Hepatitis D, Hepatitis C

75
Q

What is Acute Pancreatitis

A

Acinar Cell injury that leads to intracellular activation of enzymes and auto-digestion of pancreas

76
Q

What causes Acute Pancreatitis

A

Alcohol and Gallstones

77
Q

Sx of Acute Pancreatitis

A

Epigastric pain that is constant and radiates to the back
Pain is worse with walking, relieved with leaning forward, sitting, fetal position
N/V
Cullen’s Sign: Periumbilcal Ecchymosis
Grey Turner’s Sign: Flank Echhymosis

78
Q

Dx of Acute Pancreatitis

A
Abdominal CT is test of choice
Abdominal Ultrasound to r/u gallstones
Lipase
Amylase >3x ULN
ALT: Increased suggests gallstone pancreatitis
Hypocalcemia
79
Q

Tx of Acute Pancreatitis

A

Supportive: NPO, IV fluids, Demerol
Abx not used
ERCP

80
Q

What is Chronic Pancreatitis

A

Loss of exocrine and sometimes endocrine function

81
Q

What causes Chronic Pancreatitis

A

Alcohol Abuse or Idiopathic

CF causes exocrine insufficiency

82
Q

Sx of Chronic Pancreatitis

A

Calcifications + Steatorrhea + DM

83
Q

Dx of Chronic Pancreatitis

A

Calcified Pancreas

Amylase and Lipase are usually ok

84
Q

Tx of Chronic Pancreatitis

A

Oral Pancreatic Enzyme Replacement
Stop Alcohol
Pain Control

85
Q

What are RF for Pancreatic Cancer

A

Smoking, Older Age, Alcohol, Chronic Pancreatitis, DM

86
Q

What is the most common form of Pancreatic cancer and what part of the pancreas does it affect

A

Adenocarcinoma

Head of Pancreas

87
Q

Sx of Pancreatic Cancer

A

Painless Jaundice
Weight Loss, Abdominal Pain that radiates to back, pruritis
Courvoisier’s Sign: Palpable nontender distended gallbladder associated with juandicd

88
Q

Dx of Pancreatic Cancer

A

CT Scan is first choice

Tumor Marker: CA 19-9

89
Q

Tx of Pancreatic Cancer

A

Whipple Procedure

ERCP with stent is palliative

90
Q

What is Celiac Disease

A

Small bowel autoimmune inflammatory secondary to alpha-gliadin in gluten leads to loss of villi and absorptive areas
Causes impaired fat absorption

91
Q

Sx of Celiac Disease

A

Malabsorption: Diarrhea, Abdominal Pain/Distention, Bloating, Steatorrhea
Dermatitis Herpetiformis, Pruritis, Papulovesicular rash on extensor surfaces, neck, trunk, scalp

92
Q

Dx of Celiac Disease

A

Positive Endomysial AgA antibodies and Transglutaminase Antibodies
Small bowel biopsy is definitive

93
Q

Tx of Celiac Disease

A

Gluten Free Diet (avoid wheat, rye, barley)

Oats, rice, and corn are ok

94
Q

What is Appendicitis

A

Obstruction of appendix usually due to fecalith

95
Q

Sx of Appendicitis

A

Anorexia, Periumbilical/Epigastric pain followed by RLQ pain, N/V
Rebound Tenderness, Rigidity, Guarding
Rovsing Sign: RLQ pain with LLQ palpation
Obturator Sign: RLQ pain with internal and external hip rotation with bent knee
Psoas Sign: RLQ pain with right hip flexion/extension
McBurney’s Point Tenderness: The point 1/3 distance from anterior superior iliac spine and navel

96
Q

Dx of Appendicitis

A

CT Scan
Ultrasound
Leukocytosis

97
Q

Tx of Appendicitis

A

Appendectomy

98
Q

What is Irritable Bowel Syndrome

A

Chronic, Functional Idiopathic disorder with no organic cause

99
Q

Sx of IBS

A

Abdominal pain with altered defection/bowel habits

100
Q

Dx of IBS

A

Abdominal pain or discomfort for at least 12 weeks with relief with defecation, change in stool frequency and stool formation

101
Q

Tx of IBSS

A

Lifestyle change
Anticholinergics/Spasms for diarrhea
Prokinetics, Bulk Forming laxatives for constipation
TCA (Amitriptyline) and SSR for pain

102
Q

What is Inflammatory Bowel Disease

A

Ulcerative Colitis vs. Crohn’s Disease

103
Q

What is Crohn’s Disease

A

Affects any segment of the GI from mouth to anus
Most common in terminal ileum
Depth is transural

104
Q

Sx of Crohn’s Disease

A

RLQ pain, diarrhea without blood

105
Q

Dx of Crohn’s Disease

A

Upper GI series is test of choice
Colonoscopy shows skip lesions and cobblestone appearance
Labs show Positive ASCA
Surgery is NOT curative

106
Q

What is Ulcerative Colitis

A

Limited to Colon, Starts in Rectum and moves up to colon

Depth is mucosa and submucosa

107
Q

Sx of Ulcerative Colitis

A

Abdominal Pain, LLQ, Colicky, Tenesmus, Bloody Diarrhea, Stools with mucus/pus, Hematochezia
Smoking decreases risk of UC

108
Q

Dx of Ulcerative Colitis

A

Flexible Sigmoidoscopy is test of choice for acute disease
Colonoscopy: see uniform inflammation, sandpaper appearance, pseudo polyps
Labs show P-ANCA
Surgery is curative

109
Q

Tx for both Crohn’s and UC

A

Aminosalicylates for anti-inflammatory agent (Oral mesalamine, Topical Mesalamine)
Corticosteroids for acute flares
Immune Modfying Agents: 6-Mercaptopurine
Anti-TNF agents: Adalimumab, Infliximab, Certolizumab

110
Q

What is Colorectal Cancer

A

Progression of adenomatous polyps into Adenocarcinoma

111
Q

RF of Colorectal Cancer

A

AGe >50yrs
UC/Crohn’s
Polyps, Family hx
Low fiber diet, High red/processed meats

112
Q

Sx of Colorectal Cancer

A

Iron deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits

113
Q

Dx of Colorectal Cancer

A

Colonoscopy with Biopsy
Barium Enema, see apple core lesion
Increased CEA

114
Q

Tx of Colorectal Cancer

A

5FU is mainstay of chemo

Surgical resection

115
Q

Screening for Colorectal Cancer

A

Normal: 50yrs, colonoscopy every 10
1st degree relative >60yrs: 40yrs, Colonoscopy every 10 yrs
1st degree relative

116
Q

What is an Indirect Inguinal Hernia

A

Follows inguinal canal due to persistent patent process vaginalis (contents follow testicle tract into scrotum)

117
Q

What is a Direct Inguinal Hernia

A

Weakness in Hesselbach’s Triangle (degenerative). Doesn’t reach scrotum

118
Q

What is an incarcerated hernia vs. strangulated hernia

A

Incarcerated: Irreducible hernia, usually painful
Strangulated: Irreducible with compromised blood supply

119
Q

What are hemorrhoids

A

Enlarged venous plexus that increases with venous pressure, worse with pregnancy, defecation, prolonged sitting, obesity

120
Q

Sx of hemorrhoids

A

Internal: Intermittent rectal bleeding, bright red blood per rectum, not painful
External: Perianal Pain, Aggravated with defecation

121
Q

Dx of hemorrhoids

A

Visual Inspection, DRE, Fecal Occult Blood Testing

Proctosigmoidoscopy, Colonoscopy

122
Q

Tx of Hemorrhoids

A

Conservative: High fiber diet, increased fluids, warm sitz baths, topical hydrocortisone
Surgical if debilitating pain or strangulation

123
Q

What is an Anal Fistula

A

Results from bacterial infection of anal ducts/glands

124
Q

What pathogens are most involved in Anal Fistula

A

E.Coli, Staph. Aureus, Proteus

125
Q

Sx of Anal Fistula

A

Throbbing Rectal Pain

Worse with sitting, coughing, defecation

126
Q

Tx of Anal Fistula

A

Incision and Drainage, No Abx

127
Q

What is an Anal Fissure

A

Linear Tear/Crack in the distal anal canal, usually posterior midline

128
Q

Sx of Anal Fissure

A

Severe painful bowel mveoments, patient may refrain from having BM, Constipation, Bright red blood per rectum, rectal pain

129
Q

Tx of Anal Fissure

A

Warm Sitz Bath

Analgesics, Stool Softeners, High Fiber Diet, Laxatives