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Flashcards in GI Uworld Deck (201):
1

What intervention provides the long term relief for Duodenal Ulcer

antibiotics and pantoprazole

2

majority of duodenal ulcers caused by

H pylori or NSAIDs

3

which defect in abdominal wall is not covered by membrane or skin

gastroschisis

4

rapid periumbilical pain that is out of proportion to exam findings

acute mesenteric ischemia

5

risk factors for acute mesenteric ischemia

atherosclerosis
embolic source
hypercoagulable

6

lab values in acute mesenteric ischemia

leukocytosis
elevated amylase and phosphate levles
metabolic acidosis

7

Dx acute mesenteric ischemia

CT angiography

8

indications of worsening SBO

fever, hemodynamic instability (hypotension and tachy)
guarding
luekocytosis
low bicarb!! metabolic acidosis

9

no Ab anti tissue transaminases but Bx shows villous atrophy

celiacs still

10

confirm Dx pyloric stenosis

US

11

30 yo with vomting and abdominal pain for 24 hours. crampy diffuse getting worse. BM 3 days ago
emesis is green no blood
dec appetite
distended bowel with hyperactive sounds and diffusely tender
normal electrolytes and cBC

SBO from adhesions is most likely

12

best Dx image for pancreatic CA

CT

13

neonate with bilious vomting

malrotation, volvulus

14

NG tube placed in neonate with bilious vomtiing and there is no free air in stomach (aka no double bubble)

now do upper GI series
barium swallow

15

most common cause lower GI bleeding in adults

diverticulosis

16

painless bleeding from rectum in adult

diverticulosis

17

reye sundrome presentaion

vomiting, agitation, irrational behavior
progressing lethargy, stupor and restlessness

18

lab findings in reye syndrome

hyperammonemia
normal or slighly elevated bili and alk phos
long PT
hypoglycemia
mod t osevere inc LFTs and LDH

19

microvesicular steatosis in kidneys and brain

reye syndrome

20

when to suspect spontaneous bacterial peritonitis

any patient with cirrhosis and ascites accompanied by fever or change in mental status

21

Abdomainl XR findings in necrotizing enterocolitis

air in bowel wall "train track or double line"
and portal veins
"pneumatosis intestinalis"

22

pneumatosis intestinalis

from NEC in newborn. risk with prematurity

23

what cause zenker diverticulum

sphincter dysfunction and esophageal dymotility

24

typical GERD findings in patient, next step

Upper GI endoscopy

25

biggest risk factor for pancreatitis

alcohol consumptions

26

Tx appendiceal abscess

IV hydration, Antibiotics, bowel rest and interval appendectomy

27

anemia in patient taking aspirin and NSAID

likely Fe deficient from chronic bleeding

28

what happens in anemia of chronic disease

suppresion RBC production by inflammatory cytokines

29

what type of damage in reye syndrome

microvesicular fatty infiltration

30

best Dx for acute gallstone pancreatitis

RUQ US if inconclusive the ERCP

31

chronic alcoholic with cirrhosis with vague symptoms like weakness and fatigue, next step

esophageal endoscopy
and US of liver every 6 months to look for hepatocellular carcinoma

32

when do you introduce pureed foods to infants

6 months

33

when to introduce cows milk to infants

1 year

34

why does rifaxamin help with encephalopath

decrease number of ammonia producing bacteria in colon

35

why is there steatorrhea in zollinger ellison

inactivation of pancreatic enzymes by increased stomach acid

36

crypt abscesses

UC

37

porphyria cutanea tarda

fragile skin, photosensitivity and vesicles and erosions on dorsum of hands
seen in Hep C

38

HCV patients also have what condition usually

essential mixed cryoglobulinemia

39

waxing and waning transaminase levels

Hep C

40

CF findings

recurrent infections
growth failure
steatorrhea, malabsorption ADEK
because malabsorption K can have higher susceptibility to bleeding and bruising

41

tests for CF

sweat Cl testing
fecal elastase
genotyping

42

CF patients at risk for

pancreatitis, DM and infertility

43

what meds are assoc with acute pancreatitis

valproic acid
diuretics: furosemid and thiazides
drugs for IBD: ASA and sulfasalazine
immuno: azathioprine
HIV: didanosine and pentamidine
antibiotics: metro and tetracycline

44

test for lactulose intolerance

+ H breath test
low stool pH and increased stool osmotic gap

45

nonalcoholic fatty liver disease

middle aged obese with metabolic syndrome
bland steatosis to ecrosis to cirrhosis
macrovesicular fat deposition and peripheral displacement nuclei

46

What is nonalcoholic fatty liver disease related to

insulin R and increased peripheral lipolysis TG synthesis and hepatic uptake

47

triple bubble sign

jejunal atresia

48

what increases risk for GI atresia in utero

mom using vasoconstrictive meds or tobacco or cocaine

49

severe pancreatitis causes hypotension how

increased vascular permeability

50

most common liver mass

metastatsis
solid or multiple

51

anti HBs +
anti HBc +

resolved hep B infection

52

when do you have antiHBe +

recovery phase of HBV

53

what Ab if you are immune to Hep B from natural infection

IgG anti HBc and Anti HBs

54

Tx for duodenal hematoma in child

NG suction and parenteral nutrition

55

Tx for acute cholescytisis

cholecystectomy within 72 hours

56

radiology of acalculous cholecystiis

gallbladder thickening and distension
pericholecystic fluid

57

Tx for acalculous cholecystitis

percutaneous cholecytostomy under radiologic guidance

58

Patients with acalculous cholecystitis

critically ill

59

Tx for diverticulitis with abscess formation

CT guided percutaneous drainage

60

labs in intrahepatic cholestasis of preganncy

intense pruritis
elevated bile acids
elevated LFTs
Dx of exclusion

61

associated disorder in hirschspurng

downs

62

ileal obstruction of meconium

CF

63

brick red urate crystals in diapers

sign of mild dehydration

64

Tx for breastfeeding failur jaundice in newborn

increase frequency of feedings and duration

65

3 week old with jaundice and pale stool
breast feeding well
increased direct bili
coombs negative

biliary atresia

66

how to Dx biliary atresia

intraoperative cholangiogram

67

first step in Dx biliary atresia

abnormal US to look for abnormal or absent gallbladder

68

kasai procedure

used in biliary atresia
hepatoportoenterostomy
allows time for growth and reduces the mortality assoc with hepatic transplant in same age group

69

when does physiologic jaundice resolve

in first week

70

when does breast milk jaundice occur

second week
increased unconjugated bili up to 10-30

71

CXR findings in acute pancreatitis

can have any:
pleural effusion
atelectasis
elevated hemidiaphragm
pulmonary infiltrates

72

hepatolenticular degeneration

wilsons disease

73

what cardiac drug increases serum digoxin levels

CCBs like amiodarone, verapamil, quinidine

74

signs Sx dig toxicity

anorexia
n/v
abdominal pain
fatigue
confusion
weakness
color vision abnormalities

75

where is a mallory weiss tear

mucosal tear at the GEJ

76

Hepatorenal syndrome

dangerous complication ESRD
decreased GFR in absence of schock, proteinuria or other causes renal dysfunction
type 1 is rapid
type 2 survive 3-6 months

77

Tx for hepatorenal syndrome

renal transplant

78

painless GI bleeding

angiodysplasia most common in right colon
so if vignette says colonoscopy years ago could not visualize ascending colon

79

angiodysplasia of colon is more common in what patients

aortic stenosis, vWdisease, renal disease

80

Tx angiodysplasia colon

cautery

81

keratomalacia

cloudy cornea

82

bilious emesis in neonate
work up

Abdominal XR to rule out pneumoperitoneum
then water soluble contrast enema

83

microcolon

meconium ileus

84

abnormal D xylose

low levels= celiac
would be normal in pancreatitis because is absorbed in proximal small intestine without enzymes or brush border

85

clinical feature achalasia

chronic dysphagia, progressive solids to liquids

86

Dx acalculous cholecystitis

Abdominal US

87

neutrophilic cryptitis

both crohns and UC

88

recurrent PUD with multiple duodenal ulcers and jejunal ulcers
thickened gastric folds

suspect zollinger ellison
gastrinoma

89

risk with hiatal hernia

adenocarcinoma of esophagus because cause gERD which inc risk for CA

90

Dx chronic pancreatitis

CT to look for pancreatic calcifications

91

management variceal hemorrhage

volume resuscitation
IV octreotide
antibiotics

92

what non antibiotics increase risk c diff

long term PPI use or histamine 2 R antagonist use

93

first step to dx acute pancreatitis

serum amylase and lipase

94

liver is black
hyper direct bili
pigment in hepatocytes

dubin johnson

95

how to confirm dubin johnson

coproporphyrin urine levels will be high

96

absent bowel sounds and dilated small and large bowel

paralytic ileus

97

man had gastroduodenoscopy showing antral ulcer and 4/7 biopsies are consistent with adenocarcionma
next step?

CT scan

98

what is panendoscopy

esophagoscopy
bronchoscopy
laryngoscopy

99

Blunt abdominal trauma and has low BP ad no peritoneal signs or anything

splenic laceration

100

Tx toxic megacolon

IV fluids
antibiotics
IV corticosteroids for IBD induced
bowel rest

101

newborn with feeding intolerance, abdominal distension and bloody stools

NEC

102

why are newborn with congenital heart disease more prone to NEC

lack of perfusion of mesentary

103

patient with acute pancreatitis likely to stones, resolves
now what?

cholescystectomy to prevent further acute pancreatitis episodes

104

difficulty initiating swallowing
next step

videofluoroscopuc modified barium swallow

105

recurrent right lower lobe pneumonia in elderly patient...

likely aspiration

106

child has hemi hyperplasia of body

beckwith wiedemann

107

what is the mutation in beckwith wiedemann

deregulation of imprinted gene on chrom 11p15

108

macrosomia macroglossia, hemihyperplasia
likely to have what abdominal defect

omphalocele
beckwith wiedemann

109

complications beckwith wiedemann

wilms tumor
hepatoblastoma

110

congenital disorder of tryptophan absorption

hartnup
they get pellagra

111

Acute intermittent porphyria

abdominal pain, vomiting, diarrhea
neuro Sx of agitation, paresthesias, confusion

112

SLE like malar rash
diarrhea

pellagra

113

week after Blunt abdominal trauma comes back with shaking chills poor appetite and deep abdominal pain

pancreatic laceration

114

if there is air in urine of a patient

evaluate for colovesical fistula

115

how to Dx colovesical fistula

abdominal CT with oral or recta contrast
do not use IV
colonoscopy to tule out malignancy

116

common cause post op ileus

opiate use

117

8 year old with extrahepatic cystic mass and normal gallbladder

biliary cyst

118

signs of biliary cyst

abdominal pain and obstructive jaundice

119

Tx biliary cyst in child

surgical resection to preven obstruction and malignant transformation

120

someone on total parenteral nutrition and has gallstones, why

gallbladder stasis

121

non caseating granulomas. which IBD

crohns

122

most common causes of cirrhosis

chronic Hep B or C
alcoholic
nonalcoholic
hemochromatosis

123

anticoagulated patient with weakness and dizziness and evidence anemia
back pain

internal hemorrhage
retroperitoneal

124

which polyp in colon is most premalignant

villous adenoma

125

colon cancer more in sessile polyps or stalked(pedunculated)

sessile

126

26 year old with 4 weeks intermitten abdominal pain and cramps with rectal urgency and bloody diarrhea, nausea and de appetite
getting more severe
no PMH
fever and lower BP high HR
distension with diffuse tenderness and mucus mixed blood in vault. anemic with lots of leukoctyes and inc ESR

After IV fluids do abdominal XR to Dx toxic megacolon

127

vit B12 stores last how long

3-4 years

128

rotors syndrome is a defect in what

defect in hepatic excretion of bilirubin
will have + urine dip for bilirubin with negative urobilinogen

129

panlobular mononuclear infiltration of liver

hepatic cell necrosis

130

biggest intervention to decrease risk pancreatic cancer

smoking cessation

131

Tx for PBC

ursodeoxycholic acid
delays progression

132


Ca all around gallbladder

porcelain
increased risk of adenocarcinoma

133

hepatic encephalopathy occurs why

livers inability to break down ammonia into urea

134

hepatic hydrothorax results in

transudative pleural effusions

135

patient with cirrhosis and large pleural effusion that wont go away with diuretics

transjugular intrahepatic portosystemic shunt

136

elevated direct bilirubin
elevated alk phos

cholestasis
intra or extrahepatic
extra will have dilated ducts
intra does not

137

most common mets colon CA

liver

138

hard hepatomegaly and mildly elevated liver enzymes

do CT to look for malignancy

139

what helps prevent variceal bleeding

beta blockers propanolol nadolol

140

if patient with varices in esophagus has CI to beta blocker therapy

do endoscopic ligating

141

courvoisier sign

nontender! distended gallbladder at right costal margin
seen in pancreatic cancer from back up

142

surgery for gastroschisis

single stage closure

143

surgery for omphalocele

staged closure with silastic silo

144

biopsy of colon with laxative abuse

dark brown discoloratino of colon with lymph follicles shining through as pale patches "melanosis coli"
pigment in macrophages of lamina propria

145

most important indicator of acute hepatic failure

PT will increase

146

lab values that indicate acute liver failure

increased PT and INR
bilirbuin inc
transaminases can decrease

147

signs of B2 riboflavin def

angular cheilosis, stomatitis, glossitis
normocytic anemia
seborrheic dermatitis

148

signs of scurvy

punctate hemorrhage
gingivitis
corkscrew hair

149

Lynch syndrome

HNPCC

150

Lynch syndrome II is assoc with

endometrial CA

151

rehydration for children

oral if mild
mod-severe use normal saline

152

area commonly involved in ischemic colitis

splenic flxsure

153

presentation of achalasia but also with weight loss and rapid onset

think of malignancy causing psuedoachalasia
do an endoscopy

154

Tx for acute cholangitis

ERCP with spincterotomy

155

acute errosive gastritis

severe hemorrhagic erosive lesions after exposure to injurious agents

156

close contacts of someone with Hep A

give Ig

157

Dx carcinoid syndrome

urinary excretion 5HIAA
CT.MRI abdomen and pelvis
octreoscan
echo

158

features carcinoid

episodic flushing
secretory diarrhea
cutaneous telangiectasias
bronchospasm
tricuspid regurg

159

risk factors for milk protein induced colitis

FMH allergies, eczema, asthma

160

what causes the ascites in portal HTN

increased hydrostatic P

161

SAAG to indicate portal HTN

>1.1

162

SAAG to indicate other causes

163

elevated AST and ALT with a ration

NAFLD

164

when to begin screening colonoscopies in patients with IBD

begin 8 years post Dx
colonoscopy with Bx every 1-2 years

165

bowel sounds in acute ischemia

decreased

166

bowel sounds in SBO

increased

167

suspect pancreatic CA, how does jaundice affect workup

if they are jaundiced first do US
no jaundice then do CT

168

what to give patient on warfarin if need immediate surgery

FFP

169

MEN I

primary PTH
enteropancreatic tumors
Pituitary

170

MEN2A

Medullary thyroid
Pheo
PTH hyerplasia

171

MEN2B

Medullary thyroid
Pheo
mucosal and intestinal neuromas
marfanoid

172

Tx for anal fissures after stool softeners and sitz baths

topical lidocaine and nifedipine

173

post gastrectomy complications

dumping syndrome
loss of normal action pyloric sphincter and rapid empyting of gastric contents

174

signs of dumping syndrome

abdominal pain, diarrhea, nausea
hypotension.tachy
dizziness, confusion, fatigue diaphoresis

175

presentation emphysematous cholecystitis

fever, RUQ pain, n/v
crepitus adjacent to gallbladder

176

Dx emphysematous cholecystitis

air fluid in gallbladder, gas in gallbladder wall
cultures with clostridium or E coli
indirect hyperbili with mildly elevated LFTs

177

tx emphysematous cholecystitis

EM cholecystectom
broad spec antibiotics

178

zinc deficiency

alopecia
abnormal taste
bullous pustulous lesions

179

testing to H pylori

breath or stool

180

if H pylori testing is negative, next step

PPI trial for 4-6 weeks

181

what pills induce esophagitis

tetracyclines
Aspirin and NSAIDs
bisphosphonates
KCl

182

choanal atresia

newborn with cyanosis aggravated by feeding and relieved by crying

183

CHARGE syndrome

coloboma, heart defects, atresia choanae, retardation of growth, GU anomalies, ear abnormalities/deafness

184

Dx choanal atresia

failure to pass oropharynx catheter
confirmed by CT

185

Tx MALT lymphoma

since caused by H pylori do the PPI clarithromycin and amoxicillin regimen

186

ischemic hepatopathy

rapid and massive increase in transaminases

187

pleural effusion fluid has low pH and very high amylase
alcoholic

assume booerhave syndrome and esophageal perforation
will have pneumomediastinum

188

cholesterol emboli

livedo reticularis
acute kidney injury
pancreatitis and mesenteric ischemia
supportive care for pancreatitis

189

immunizationf for people with HCV

Hep B and A

190

GGT and ferritin levels in alcoholic hepatitis

both are increased

191

dermatitis herpetiformis

erythematous vesicular rash over extensor surfaces elbows and knees

192

management pyloric stenosis

first IV hydratio and K replacement then surgery

193

Dx acute diverticulitis

abdominal CT with contrast

194

Dx hyperTG as cause of pancreatitis

fasting lipid profile
lipase will be like extremely high high

195

how to Dx psoas abscess

CT of abdomen and pelvis

196

abnormal lab value in patients with only upper GI bleed

inc BUN/Cr ration from increased urea in intestinal breakdown of Hb and increased reabsorption for hypovolemia

197

19 year old Dx with FAP

need elective procto-colectomy

198

cyclical vomiting syndrome is highest in children with Hx of what

migraine HA

199

Tx for cyclical vomiting syndrome

hydration and antiemetics

200

coffee bean sign

sigmoid volvulus

201

what cause spider angiomas and palmar erythema in cirrhosis

hyperestrinism from impaired hepatic metabolism of circulating estrogens
P450 cytochrome system