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Clin Lab II > GI pt 2 > Flashcards

GI pt 2 Flashcards

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1
Q

What are the noninvasive labs for H pylori?

A

urea breath test, stool antigen test, serologic test

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2
Q

What are the invasive tests for H pylori?

A

If patient is having an EGD, testing can be done on biopsy samples
- CLO test aka rapid urease test
- PCR detection of H. pylori DNA
- Histological examination/staining
- Culture

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3
Q

What are the tests we can do for the SI?

A

gastrin, fecal fat, sudan III, anti-tissue transglutaminase Ab, and anti-endomysial ab

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4
Q

With a gastrin test, what are we looking for?

A

duodenal ulcers

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5
Q

With a fecal fat test, what are we looking for?

A

malabsorption of fat or pancreatic insufficiency

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6
Q

With a sudan III test, what are we looking for?

A

malabsorption of fat

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7
Q

With an anti-tissue transglutaminase ab test, what are we looking for?

A

celiac disease

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8
Q

With an anti-endomysial ab test, what are we looking for?

A

celiac disease

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9
Q

What are the tests for the large intestine?

A

Fecal occult blood test, stool culture, ova and parasites, stool WBCs, lactoferrin, fecal calprotectin, and specific pathogen testing

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10
Q

What are the tests we can for the pancreas?

A

Amylase, Lipase, fecal elastase, and fecal fat test

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11
Q

With a fecal occult blood test, what are we looking for?

A

aka Guaiac
stool specimen needed

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12
Q

With an ova and parasites test, what are we looking for?

A

microscopic evaluation

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13
Q

With a stool WBCs test, what are we looking for?

A

infectious process

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14
Q

With a lactoferrin test, what are we looking for?

A

inflammatory processes
nonspecific

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15
Q

With a fecal calprotectin test, what are we looking for?

A

Crohn’s disease

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16
Q

With an amylase test, what are we looking for?

A

looking for it to be high
could indicate pancreatitis but is non specific

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17
Q

With a lipase test, what are we looking for?

A

THIS IS THE TEST OF CHOICE FOR PANCREATITIS
we are looking for it to be high

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18
Q

With a fecal elastase test, what are we looking for?

A

pancreatic insufficiency
we are looking for it to be low

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19
Q

With a fecal fat test, what are we looking for?

A

we use this more in clinical practice and it is more specific
can indicate pancreatic insufficiency
we are looking to see if it is high

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20
Q

Which bacterial pathogens TEST OF CHOICE is a stool culture?

A

Salmonella
Shigella
Campylobacter
Shiga Toxin (E. coli)

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21
Q

Which bacterial pathogens TEST OF CHOICE is antigen detection?

A

E. coli
C Diff (GDH antigen, Toxin A and Toxin B)

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22
Q

Which bacterial pathogens have bloody diarrhea?

A

Shiga, Campylobacter, Salmonella, and E. coli

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23
Q

what is the test of choice for rotavirus?

A

rapid antigen test

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24
Q

What is the test of choice for norovirus?

A

PCR testing available
usually a CLINICAL diagnosis

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25
What are the Protozoan pathogens?
Entamoeba histolytica Giardia Cryptosporidium
26
What are the nematode pathogens?
Ascaris lumbricoides Nectar americanus Strongyloides Enterobius vermicularis
27
What protozoan or nematode infections cause bloody diarrhea?
Entamoeba histolytica
28
What is the test of choice for Entamoeba histolytica?
ova and parasites antigen detection or PCR testing
29
What is the test of choice for Giardia?
ova and parasites antigen detection
30
What is the test of choice for cryptosporidium?
antigen or PCR testing
31
What nematode pathogens have a microscopic evaluation as their test of choice?
Ascaris lumbricoides Nectar americanus Strongyloides
32
What is the test of choice for Enterobius?
scotch tape test
33
What labs can we order to assess the function of the liver?
albumin PT/INR Bilirubin platelets cholesterol BUN glucose ammonia
34
What labs can we order to assess injury/insult of the liver?
AST, ALT, Alk Phos, GGT
35
What labs can we order to assess infection of the liver?
hepatitis
36
What are some other niche liver tests we can do to assess processes in the liver?
ascitic fluid analysis, SAAG, de Ritis ratio, anti-mitochondrial Ab, anti-smooth muscle Ab
37
Describe the functions of the liver, the corresponding lab, and the lab abnormality in liver disease
38
Describe what it means to be prehepatic, hepatic, and post-hepatic with associated lab values and examples
39
positive IgM would indicate?
active infection
40
positive IgG would indicate?
either active infection or past infection
41
positive antigen would indicate?
active infection
42
positive antibody would indicate?
past infection or vaccination
43
positive DNA would indicate?
active infection
44
In hepatitis B, C, and D, because of there blood and sexual contact route of transmission, what other disease are they more likely to get?
They are more likely to develop chronic hepatitis and it may lead to hepatocellular carcinoma
45
Describe the incubation, transmission, chronic infection and risk of liver cancer for the hepatitis'
46
What are the labs and treatments for Hep A?
Acute Infection: positive IgM Past Infection: positive IgG TX: self-limiting
47
What are the labs and treatments for Hep B?
Acute Infection - positive antigen - positive DNA - positive Ab - positive IgM Chronic Infection - positive antigen - positive DNA - positive Ab - positive IgG Past infection - positive antibody - positive IgG TX: vaccine available
48
What are the labs and treatments for Hep C?
Acute Infection: - positive antibody - positive RNA Past Infection - positive antibody - positive RNA TX: no vaccine, anti-viral therapy
49
What are the labs and treatments for Hep D?
requires coinfection with Hep B. Cannot replicate on its own. Acute infection: - positive antigen - positive antibody - positive IgM TX: HepB vaccine
50
What are the labs and treatments for Hep E?
Typically diagnosed w/ sx. Need to rule out Hep A. Increased mortality in pregnant females TX: self-limiting
51
With a SAAG, what are we looking for?
used to distinguish cause of ascites based on the difference between the albumin level of serum and of ascitic fluid
52
With de Ritis ratio, what are we looking for?
used to distinguish between different types of hepatitis (AST/ALT)
53
With an anti-mitochondrial antibody, what are we looking for?
primary biliary cholangitis/ cirrhosis
54
With an anti-smooth muscle antibody, what are we looking for?
autoimmune hepatitis
55
What is the cancer marker for colorectal cancer?
CEA (carcinoembryonic antigen)
56
What is the cancer marker for pancreatic cancer?
C19-9
57
What is the tumor marker for liver cancer?
AFP (alpha fetoprotein)
58
What are the types of abdominal x-rays?
Plain Films - acute abdominal series - KUB With contrast - barium swallow - upper GI series - upper GI series w/ small bowel follow thru - lower GI series - barium enema
59
What is the technique for looking at abdominal x rays?
ABDO X Air, Bowel, Dense stuff, organs, and extra
60
What is the pathology? What is the type of image?
normal abdominal x ray
61
What is the pathology? What is the type of image?
Normal but we can see the bladder where the arrow is. abdominal x-ray
62
What is the pathology? What is the type of image?
free air under the diaphragm abdominal x-ray
63
What is the pathology? What is the type of image?
dilated loops of bowel and air fluid levels are indicative of an obstruction abdominal x-ray
64
What is the pathology? What is the type of image?
gastric outlet obstruction/ syndrome abdominal x ryay
65
What is the pathology? What is the type of image?
air fluid levels and hip replacement artifact on left lateral decubitus abdominal x-ray
66
What is the pathology? What is the type of image?
free air indicated where the white arrow is. dilated loops of bowl and air fluid levels indicative of an obstruction on cross table view on abdominal x-ray
67
What is the pathology? What is the type of image?
mass and narrowing of the GE junction barium swallow
68
What is the pathology? What is the type of image?
polyp do EGD next Contrast should turn everything white in the stomach. barium swallow
69
What is the pathology? What is the type of image?
balloon appearance or "birds beak" or "rat tail" stricture at the bottom this is indicative of achalasia barium swallow
70
What is the pathology? What is the type of image?
normal small bowel follow-through
71
What is the pathology? What is the type of image?
noraml barium enema
72
What is the 3-6-9 rule?
SI less than 3 cm LI less than 6 cm cecum less than 9 cm
73
What is the pathology? What is the type of image?
normal SI on the right, then the red and green arrows indicate an obstructive process. We should definitely be sending this patient for CT after this GI x-ray w/ contrast
74
What is the pathology? What is the type of image?
the transverse colon is not normal in diameter and it is severely narrowed. Sometimes referred to as an "apple core" lesion
75
What are the types of abdominal CTs?
abdomen only abdomen and pelvis
76
What are the types of contrast for abdominal CT?
IV contrast only Oral contrast only IV and oral contrast No contrast
77
When would we do IV contrast only?
masses, acute mesenteric ischemia
78
When would we do Oral contrast only?
if the patient has kidney disease
79
When would we do IV and Oral contrast?
wanna see what lights up and what doesn't
80
When would we use no contrast?
bones and stones
81
What are the special types of CT and what would they show?
1. Angiography: mesentery ischemia (THIS IS GOLD STANDARD) 2. Enterography: look more specifically at the walls of intestines 3. Chest: esophagus (maybe, more helpful to get CT abd)
82
What is the pathology? What is the type of image?
normal abdominal CT
83
What is the pathology? What is the type of image?
pancreatic mass on abdominal CT
84
What is the pathology? What is the type of image?
dilated loops of bowel and abdominal distension on abdominal CT of the intestines
85
What is the pathology? What is the type of image?
dilated loops of bowel on abdominal CT of the intestines
86
What is the pathology? What is the type of image?
ascites oral contrast in stomach Abdominal CT (liver/gallbladder/pancreas)
87
What is the pathology? What is the type of image?
echogenicity of the liver (is isn't all the same color) It should be consistent. This indicates metastasis Abdominal CT (liver/gallbladder/pancreas)
88
What is the pathology? What is the type of image?
distension of the gallbladder with pancreatic mass. we can see the aorta and kidney light up a ton so we know they used IV contrast Abdominal CT (liver/gallbladder/pancreas)
89
What is the pathology?
Blood clot or narrowing due to atherosclerosis. blockage in the blood flow that will lead to mesentery ischemia
90
What is the pathology?
IVC filter
91
What is the pathology? What is the type of image?
normal gastric emptying study moves through the SI to Li 30-120 mins
92
What organs can we evaluate with US?
1. Esophagus: endoscopic otherwise not used 2. Liver 3. gallbladder 4. pancreas
93
What are the different types of US?
1. RUQ (limited) 2. Complete Abdomen 3. Renal/Bladder 4. Pelvic
94
When is abdominal US most helpful?
most useful in evaluation of solid organs and biliary tree. - not helpful in tube like organs - endoscopic US can be used to evaluate some esophageal issues
95
What is one of the biggest perks of US?
it has no radiation, so it is safe and very important for pregnant patients
96
What are the different types of US special tests?
1. Modified Barium Swallow 2. Manometry - Pressure: esophagus, stomach, and sphincter of Oddi - pH: esophagus, stomach 3. gastric emptying study 4. tagged RBC scan 5. elastography 6. MRCP 7. HIDA scan
97
What is the pathology? What is the type of image?
dysfunction of the pyloric sphincter. doesn't move from space so concerned for gastroparesis on this gastric emptying study
98
What is the pathology? What is the type of image?
normal tagged RBC scan
99
What is the pathology? What is the type of image?
abnormal- blood flow connections occur outside where they are meant to tagged RBC scan
100
What is the pathology? What is the type of image?
normal should see movement form gallbladder to SI MRCP
101
What is the pathology? What is the type of image?
obstruction gallstone blocking contrast into SI MRCP
102
What pathology can HIDA scans indicate?
Sphincter of Oddi dysfunction
103
What is the pathology? What is the type of image?
Normal HIDA scan
104
What is the pathology? What is the type of image?
gets into gallbladder, but doesn't go anywhere else. chronic cholecystitis HIDA scan
105
What are the different scope procedures?
Endoscopic US EGD Fiberoptic Endoscopic Evaluation of Swallowing (FEES) VCE Enteroscopy Colonoscopy Sigmoidoscopy ERCP Percutaneous transhepatic cholangiography Biopsy
106
Why do we typically like to do scopes first?
direct visualization
107
What four scope procedures, do we do most often?
EGD colonoscopy sigmoidoscopy ERCP
108
What are the indications for the endoscopic US?
esophageal issues in the walls of the esophagus
109
What are the indications for VCE and Enteroscopy?
reserved for the worst-case scenario where we know something is going on in the SI. Enteroscopy has the greater risk for perforation.
110
Which four scope procedures require anesthesia?
colonoscopy sigmoidoscopy ERCP Enteroscopy
111
What are the indications for a scope?
need for direct visualization some therapuetic
112
What are the greatest risks with a scope?
perforation bleeding introduction of infection anesthesia
113
What is the pathology?
normal
114
What is the pathology?
barret's with mass
115
What is the pathology?
esophagitis
116
What is the pathology?
esophageal varices
117
What is the pathology?
normal
118
What is the pathology?
gastric mass with retropulsion of the scope
119
What is the pathology?
gastric ulcer
120
What is the pathology?
bleeding gastric ulcer
121
What is the pathology?
normal colonoscopy
122
What is the pathology?
diverticulum
123
What is the pathology?
internal hemorrhoids with the scope in the top right corner
124
What is the pathology?
mass in the colon
125
What kind of complications occur at the fundus of the stomach? and what sx would be associated with it?
hiatal hernia epigastric pain, heartburn, regurgitation, nausea
126
What kind of complications occur at the body of the stomach?
Ulcers
127
What kind of complications occur at the pylorus of the stomach? and what sx would be associated with it?
bloating, distension, N/V ulcer sx
128
What kinds of things are we looking for on imaging of the SI?
start with an x-ray. but strong suggestion of SI issues, a CT will show the "transition zone" multiple surgeries may be seen strictures adhesions N/V abdominal pain masses
128
What kinds of things are we looking for on imaging of the LI?
issues with defecation patient may have N/V
129
What kinds of things are we looking for on imaging of the liver?
acute hepatitis RUQ pain jaundice (bilirubin above 6) - will show first in sclera of the eyes and mouth - hard to see if different skin tones
130
What are the ranges of the de ritis ratio?
Acute viral hepatitis: AST and ALT VERY elevated, ALT>AST, ratio < 1 Chronic hepatitis: AST and ALT elevated, AST> ALT, ratio 1 to about 2 Alcoholic hepatitis: AST>>ALT ratio > 2, GGT also elevated
130
What kinds of things are we looking for on imaging of the gallbladder?
issues with gallstones painless jaundice = pancreatic mass/cancer
131
What kinds of things are we looking for on imaging of the pancreas?
1. Sphincter of Oddi dysfunction may be caused by biliary sludge, a mass, or stone 2. Epigastric pain with radiating to the back would indicate pancreatitis 3. Things that cause pancreatitis: alcohol, gallstones, autoimmune disease, fatty diets (overworking), ERCP may cause inflammation and introduce bacteria causing pancreatitis
132

Clin Lab II (16 decks)

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