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Flashcards in GI High Yield Deck (129):
1

What is Achalasia

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

2

Sx of Achalasia

Dysphagia to both solids and liquids

3

Dx of Achalasia

Gold Standard: Esophageal Monometry
Double Contrast Esophogram: See Birds Beak (LES narrowing)

4

Tx of Achalasia

Decreased LES pressure with Botulinum toxin injection
Nitrates, CCB, Pneumatic dilation

5

What is Zenker's Diverticulum

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

6

Sx of Zenker's Diverticulum

Dysphagia, Regurgitation, Cough, Feeling lump in neck

7

Dx of Zenker's Diverticulum

Barium Swallow

8

Tx of Zenker's Diverticulum

Observation if small and asymptomatic
Diverticulectomy, Cricopharyngeal Myotomy

9

What is Eosinophilic Esophagitis

Allergic, Inflammatory, Esophageal Inflammation

10

Sx of Eosinophilic Esophagitis

Dysphagia, especially with solids

11

Dx of Eosinophilic Esophagitis

Endoscopy: See normal or multiple corrugated rings

12

Tx of Eosinophilic Esophagitis

Remove foods that incite allergic response
Topical steroids via inhaler

13

What is usually associated with Esophageal Cancer

Smoking, Alcohol, Exposure of esophagus to noxious stimuli

14

What location is typically affected by Esophageal Cancer

Upper 1/3 of esophagus

15

Who gets Esophageal Cancer

AA 50's

16

Sx of Esophageal Cancer

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

17

Dx of Esophageal Cancer

Upper Endoscopy with Biopsy

18

Tx of Esophageal Cancer

Esophageal resection
XRT
Chemo

19

What is a Mallory-Weiss Tear

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

20

Sx of Mallory-Weiss Tear

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

21

Dxy of Mallory-Weiss Tear

Upper endoscopy with biopsy

22

Tx of Mallory-Weiss Tear

Supportive if no bleeding
If bleeding, Epinephrine injections, sclerosing agent, band ligation, hemo-clipping

23

What is a Hiatal Hernia

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

24

What causes Esophageal Varices

Portal Vein Hypertension
Dilation of gastroesophageal collateral, submucosal veins

25

Sx of Esophageal Varices

Upper GI bleed (Hematemesis, Melena, Hematochezia)

26

Dx of Esophageal Varices

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

27

Tx of Esophageal Varices

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

28

What meds to you give to prevent rebleeds in esophageal varices

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

29

What is Gastritis

Superficial inflammation/irritation of the stomach mucosa with mucosal injury

30

What causes Gastritis

H.Pylori
NSAIDS/ASA
Acute Stress

31

Sx of Gastritis

Asymptomatic
Upper GI bleed, Epigastric pain, N/V

32

What is the gold standard dx for Gastritis

Endoscopy

33

What else can you use to dx gastritis

H.Pylori testing

34

Tx for Gastritis based on H.Pylori testing

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

35

What is Peptic Ulcer Disease

Results from decreased mucosal protective factors and increased damaging factors

36

What causes PUD

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

37

What type of Peptic ulcer is more likely (location)

Duodenal is more common
More benign

38

Sx of PUD

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

39

What sx accompany a Duodenal Ulcer

Pain before meals or 2-5 hours after meals
Pain improves after eating

40

What sx accompany a Gastric Ulcer

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

41

Dx of PUD

Gold Standard: Endoscopy with Biopsy
Upper GI Series

42

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

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)

43

Tx of PUD

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

44

What is Zollinger Ellison Syndrome

A Gastrinoma (Gastrin Secreting Neuroendocrine Tumor)

45

Sx of Zollinger Ellison Syndrome

Multiple Peptic Ulceers
Refractory Ulcers
"kissing" ulcers

46

Dx of Zollinger Ellison Syndrome

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

47

Tx of Zollinger Ellison Syndrome

Surgical Resection of Tumor
If METS: PPI, Surgical resection if liver involved

48

What is the most common form of Gastric Carcinoma

Adenocarcinoma

49

Sx of Gastric Carcinoma

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

50

Dx of Gastric Carcinoma

Upper Endoscopy with biopsy
Gastrectomy, XRT, and Chemo

51

What is Pyloric Stenosis

Hypertrophy and Hyperplasia of muscular layers of pylorus
Causes a functional outlet obstruction

52

Sx of Pyloric Stenosis

Usually in newborns, nonbilous projectile vomiting
Olive shaped nontender mobile hard pylorus

53

Dx of Pyloric Stenosis

Ultrasound
Upper GI contrast study: See String Sign

54

Tx of Pyloric Stenosis

Pyloromyotomy
Rehydration

55

What is Cholelithiasis

Gallstones in Gall Bladder (not inflammatory)
90% are cholesterol

56

RF for Choleleithiasis

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

57

Sx of Cholelithiasis

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

Dx of Cholelithiasis

Ultrasound

59

Tx of Cholelithiasis

If asymptomatic: Observe
Cholecystecomy in sx patients

60

Complications of Cholelithiasis

Choledochlithiasis: Gallstones in biliary tree

61

What is Acute Cholecystitis

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

62

What pathogen is most involved in acute cholecystitis

E.Coli

63

Sx of Acute Cholecystitis

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

Dx of Acute Cholecystitis

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

65

Tx of Acute Cholecystitis

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

66

What is Choledocholithiasis

Gallbladder stones in biliary tree (common bile duct)

67

Sx of Choledocholithiasis

Biliary Colic
Jaundice

68

Tx for Choledocholithiasis

Stone extraction via ERCP

69

What is Cholangitis

Biliary tree infection secondary to obstruction by gallstones

70

Sx of Cholangitis

Charcot's Triad: Fever/Chills, RUQ pain, Jaundice
Reynold's Pentad: Shock plus AMS

71

Dx of Cholangitis

ERCP

72

Tx of Cholangitis

Penicillin + Aminoglycosides (Streptomycin, Gentamycin)

73

What forms of Hepatitis are spread by Fecal-Oral

Hepatitis A and Hepatitis E

74

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

Hepatitis B, Hepatitis D, Hepatitis C

75

What is Acute Pancreatitis

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

76

What causes Acute Pancreatitis

Alcohol and Gallstones

77

Sx of Acute Pancreatitis

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

Dx of Acute Pancreatitis

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

79

Tx of Acute Pancreatitis

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

80

What is Chronic Pancreatitis

Loss of exocrine and sometimes endocrine function

81

What causes Chronic Pancreatitis

Alcohol Abuse or Idiopathic
CF causes exocrine insufficiency

82

Sx of Chronic Pancreatitis

Calcifications + Steatorrhea + DM

83

Dx of Chronic Pancreatitis

Calcified Pancreas
Amylase and Lipase are usually ok

84

Tx of Chronic Pancreatitis

Oral Pancreatic Enzyme Replacement
Stop Alcohol
Pain Control

85

What are RF for Pancreatic Cancer

Smoking, Older Age, Alcohol, Chronic Pancreatitis, DM

86

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

Adenocarcinoma
Head of Pancreas

87

Sx of Pancreatic Cancer

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

88

Dx of Pancreatic Cancer

CT Scan is first choice
Tumor Marker: CA 19-9

89

Tx of Pancreatic Cancer

Whipple Procedure
ERCP with stent is palliative

90

What is Celiac Disease

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

91

Sx of Celiac Disease

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

92

Dx of Celiac Disease

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

93

Tx of Celiac Disease

Gluten Free Diet (avoid wheat, rye, barley)
Oats, rice, and corn are ok

94

What is Appendicitis

Obstruction of appendix usually due to fecalith

95

Sx of Appendicitis

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

Dx of Appendicitis

CT Scan
Ultrasound
Leukocytosis

97

Tx of Appendicitis

Appendectomy

98

What is Irritable Bowel Syndrome

Chronic, Functional Idiopathic disorder with no organic cause

99

Sx of IBS

Abdominal pain with altered defection/bowel habits

100

Dx of IBS

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

101

Tx of IBSS

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

102

What is Inflammatory Bowel Disease

Ulcerative Colitis vs. Crohn's Disease

103

What is Crohn's Disease

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

104

Sx of Crohn's Disease

RLQ pain, diarrhea without blood

105

Dx of Crohn's Disease

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

106

What is Ulcerative Colitis

Limited to Colon, Starts in Rectum and moves up to colon
Depth is mucosa and submucosa

107

Sx of Ulcerative Colitis

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

108

Dx of Ulcerative Colitis

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

Tx for both Crohn's and UC

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

What is Colorectal Cancer

Progression of adenomatous polyps into Adenocarcinoma

111

RF of Colorectal Cancer

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

112

Sx of Colorectal Cancer

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

113

Dx of Colorectal Cancer

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

114

Tx of Colorectal Cancer

5FU is mainstay of chemo
Surgical resection

115

Screening for Colorectal Cancer

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

116

What is an Indirect Inguinal Hernia

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

117

What is a Direct Inguinal Hernia

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

118

What is an incarcerated hernia vs. strangulated hernia

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

119

What are hemorrhoids

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

120

Sx of hemorrhoids

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

121

Dx of hemorrhoids

Visual Inspection, DRE, Fecal Occult Blood Testing
Proctosigmoidoscopy, Colonoscopy

122

Tx of Hemorrhoids

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

123

What is an Anal Fistula

Results from bacterial infection of anal ducts/glands

124

What pathogens are most involved in Anal Fistula

E.Coli, Staph. Aureus, Proteus

125

Sx of Anal Fistula

Throbbing Rectal Pain
Worse with sitting, coughing, defecation

126

Tx of Anal Fistula

Incision and Drainage, No Abx

127

What is an Anal Fissure

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

128

Sx of Anal Fissure

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

129

Tx of Anal Fissure

Warm Sitz Bath
Analgesics, Stool Softeners, High Fiber Diet, Laxatives