IMC/FM/EMED GI Flashcards by brandon lovin

Define Esophageal Ring

What syndrome can this develop

Define Esophageal Web

Schatzki ring- mucosal stricture in distal esophagus at squamocolumnar junction

Steakhouse: progressive dysphagia w/ solids eaten fast

Thin membrane across lumen in mid/upper esophagus

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? syndrome can develop w/ esophageal webs

Define Hiatal Hernia

Define Ventral Hernia

Plummer Vinson: 
Fe deficient anemia
Dysphagia
Glossitis
Cheilosis
Webs

Stomach protrudes through diaphragm via esophageal hiatus

Abdominal mass at previous incision site or d/t obesity

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When do umbilical hernias need surgical referral

What are the two types of inguinal hernias

Persists >2yrs of life

Indirect- MC
Intestine passes through inguinal ring into canal, possibly into scrotum

Direct:
Intestine passes through external ring at Hesselbach triangle, rarely enters scrotum

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Define Strangulated hernia

Define Obstructed Hernia

Define Incarcerated

Blood supply has been impaired

Irreducible hernia w/ intact blood supply

Occluded and irreducible, can progress to strangulated

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? is the main RF for esophagitis

Endoscopy for esophagitis work up shows multiple, shallow ulcers d/t ?

What are the etiologies of non-infectious esophagitis

ImmComp

HSV

Corrosive
Reflux
Eosinophilic
Medication
Radiation

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Two MC meds that cause medication induced esophagitis

When is Eosinophilic Esophagitis a considered Dx

What would be seen on barium swallow and how is it definitively dx

NSAIDs, Bisophosphonates

Asthma and GERD non-responsive to antacids

Ribbed esophagus w/ multiple corrugated rings; Biopsy

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? radiation drugs can cause esophagitis?

Radiation exposure exceeding ? much puts these Pts at risk for ?

What are the hallmark signs of infectious esophagitis

Doxorubicin
Bleomycin
Cyclophosphamide
Cisplatin

5000 cGy;
Stricture

Odynophagia- pain while swallowing food/liquids

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Since esophagitis primarily occurs in ImmComp Pts, what are the MC microbes

What would be seen on exam if etiology was fungal

What would be seen on PE if etiology was viral and how they’re Tx

C albicans
HSV
CMV

Linear yellow/white plaques w/ odynophagia

HSV- shallow punched out lesions; Acyclovir
CMV- large, solitary ulcer; Ganciclovir

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? infectious causes of esophagitis may be seen in a non-ImmComp Pt

How is esophagitis Dx

How is esophagitis Tx depending on cause

EBV
Mycobacterium

Biopsy Culture Endoscopy
Double contract esophogram

Candida: Fluconazole
HSV: acyclovir
CMV: ganciclovir
Corrosive: steroid

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Chronic GERD puts Pts at risk for ? Dz

What are Pts at risk for if the above issue develops

What is the gold standard and test of choice for Dx

Barretts; f/u screening q3-5yrs

Adenocarcinoma

Gold: pH probe; upper GI study is anatomic only
ToC: endoscopy w/ cytologic washings

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Pts w/ GERD Sxs and ? RFs are considered high risk and need endoscopy

How is GERD Tx

Age >50
Hematemesis
Weight loss
Anemia/melena
Recurrent vomiting
Dysphagia

H2 antagonist, BID
Sxs persist- switch to PPI
Continue x 8wks after Sxs are controlled

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Define Achalasia

What will be seen on swallow studies

What is the best study for Dx

Primary esophageal motility d/o w/ absent peristalsis

Bird beak/Rat tail

Manometry- shows absent peristalsis

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How is achalasia Tx

What can be used for medical therapy

What will prevent the strictures from returning after surgery

EGD dilation of esophagus or mytomy

Nitroglycerine
CCBs

PPIs

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Achalasia develops d/t loss of ? neuro structure

Define Diffuse Esophageal Spasm

What would be seen on a barium swallow

Auerbachs plexus

Non-peristaltic contractions causing pain after ingesting hot/cold substances

Corkscrew appearance

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What is the best method to confirm a Dx of esophageal spasm after a barium swallow

How is this Tx

How does esophageal cancer present

Manometry; w/ Nitrates or CCBs

Dysphagia to solids progressing to liquids w/ adenopathy

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What is the MC type of esophageal Ca

What part of the esophagus is MC affected

Hx of ? puts ? population more at risk for esophageal Ca

World: SCC
USA: Adeno d/t GERD/Barretts

Distal

Men who smoke

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How is esophageal Ca Dx

How is this Tx

What two Sxs are common indicators of gastritis

Upper endoscopy w/ biopsy- test of choice
CT for staging

Resection, Radiation, Chemo w/ 5-FU

Dyspepsia, Abdominal pain

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Acute Gastritis usually develops in ? part of stomach

What are the two types of Chronic Gastritis

Antrum

Type A- usually in fundus d/t anti-parietal Abs, associated w/ Pernicious Anemia; risk for AdenoCa

Type B- usually in antrum d/t NSAIDs, Pylori and often ASx; risk to develop PUD

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How is Gastritis Dx

What are 3 methods to detect H Pylori

How is this Tx

Endoscopy w/ 4 biopsies

Fecal Ag
Serology
Urea breath test

Mild:
Famotidine
Cimetidine
Frequent/Sev:
PPI, taper and d/c when ASx x 8wks

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What is the next step in gastritis Tx if Sxs return w/in 3months of d/c acid suppression

What RF increases incidence of gastric ulcers and slow healing time

What are the two types of ulcers and where are they MC seen

Upper endoscopy

Smoking

Duodenal- majority
Distal stomach

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How do duodenal ulcers present on exam

95% of these ulcers are caused by ?

What side of the duodenum do these present on and why is location important

Pain decreased w/ food

H Pylori

Majority: anterior
Posterior have increased bleeding risk (gastroduodenal artery) or acute pancreatitis

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PUD can rarely be caused by ? syndrome

How is this syndrome Dx

Gastric ulcers are MC found located ?

Zollinger Ellison- gastrinoma of pancreas causing excess gastrin to be released

Serum gastrin >200

Lesser curvature of antrum

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? is the MCC of non-hemorrhagic GI bleed

This MC typically presents as ?

PUD

Melena

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What is the most accurate Dx test for PUD

All Pts undergoing this test need ? additional test

What would be seen on labs/rads if an ulcer ruptured

Upper endoscopy

H pylori biopsy

Elevated serum amylase
Air under diaphragm

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How is PUD Tx When is Pylori eradication testing indicated How are Pts w/ NSAID induced PUD Tx

All Pts- PPI H Pylori: PPI Amoxicillin Metro/Clarithro 4 or more weeks after completing therapy PPI for minimum of 8wks

What is the mnemonic for gastric Ca What are the MC early Sxs What is the MC Sx

``` WEAPON: Weight loss Emesis Anorexia Pain Obstruction Nausea ``` Mild discomfort Indigestion Weight loss

What is the supraclavicular lymph node involved w/ gastric Ca What is the opposite side node involvement ? is the MC type of gastric Ca in the world

Virchows, L side R side: Hodgkins d/t etiology in mediastinum and drainage of mediastinum Adenocarcinoma

What is the most important RF for gastric Ca What are the two metastatic signs of gastric Ca This can be Dx w/ endoscopy and biopsy w/ ? lab result

H pylori Virchows- L supraclavian Mary-Joseph nodule- umbilical Linitis plastica- thickening of stomach wall d/t infiltration

How is gastric Ca Tx What blood test is used to Dx Celiac Dz How is the Dx confirmed after ? positive test

Gastrectomy Rad and Chemo IgA endomysial Ab IgA transglutaminase Ab + endymysial Ab: Intestinal mucosal biopsy from duodenal bulb

Celiac Dz may need correction of ? deficiencies What causes lactose intolerance Pts may need ? supplementation

Fe B12 Folate Ca Vit D Dec lactase to convert lactose in glucose/galactose Ca

How is lactose intolerance Dx Fecal pH test can also be performed w/ ? being normal What could make results be abnormal

Lactose breath H test += 20ppm over baseline Normally alkaline Acidic= Lactose intolerance E Coli Rotavirus

Crohns can involve anywhere in the GI tract except leaving ? unaffected What pattern would be seen on colonoscopy What type of pain/diarrhea do Pts have

Rectum Skip lesions/cobble stoning Non-bloody w/ abdominal pain

UC involves ? part of the GI tract What pattern would be seen on colonoscopy What type of pain/diarrhea do Pts have

Only colon; MC rectum Continuous erythematous/friable ulceration Bloody diarrhea w/ rare abdominal pain

? Inflammatory Bowel Dz is associated w/ perianal dzs/fistulas What radiographic finding is used to describe Crohns and UC What histological features may be seen

Crohns C: string sign in terminal ileum U: lead pipe appearance w/ lost haustral folds C: transmural, non-caseating granulomas U: mucosa only crypt abscesses

? inflammatory bowel dz is slightly protected from by smoking What serology results are used for Dx Which one has bimodal distribution of prevalence

UC Cr: ACSA UC: p-ANCA UC: 15-25, 55-65

What are two complications that can arise from UC What lab result may be seen in UC not seen in Crohns Why do UC Pts need LFTs

Toxic megacolon Colorectal Ca Anemia Inc ALP and y-glutamyl transpeptidase suggest sclerosing cholangitis

When Tx IBDz w/ Sulfasalazine, supplement Pt w/ ? Which IBDz can be cured by surgery

Folate UC

How is UC/Crohns Tx What is the next step if Pts don't respond to initial Tx What is used for acute exacerbation w/ no response to the above step If Pt still doesn't respond, what is the next step

Sulfasalazine w/ Folate Mesalamine- UC>Crohns Metronidazole Pred/Budesonide ImmSupp w/ steroids: Azathioprine 6-Mercaptopurine

What medication needs to be added to IBDz Tx in Pts w/ terminal ileal dz What meds need to be avoided What criteria is used for Dx IBS

Cholstyramine Colestipol Antidiarrheals- induces ileus ``` Rome: Pain x 3d/mon in past 3 mon w/ 2/> of: Improved w/ BM Change in frequency Consistency change ```

What are 3 common Sxs in IBS What red flags make the Rome Criteria for Dx invalid Why are labs not ordered

Bloating N/V Rectal bleeding Weight loss Fever Will be normal in IBS

How is IBS Tx Infection of C Diff leads to ? type of colitis How do Pts present

Hyoscyamine before meals for antispasmotic effect Pseudomembranous Fever w/ peritonitis and shock

How is Toxic Megacolon Dx How is it Tx ? is the MC vessel blocked during intestinal ischemia

Diameter >6cm Decompression Resection Superior Mesenteric artery

How do Pts w/ Ischemic Colitis present What would be seen on x-rays How is it Dx by gold standards and how is it Tx

PooP w/ Afib/MI/CHF Thumb print sign Angiography; Revascularization

? two meds can help prevent formation of new polyps Polyp growths are the MCC of ? in Peds These tend to be more malignant w/ ? association

ASA, Cox-2 inhibitors Painless rectal bleeding More superior in intestine they are

# Define Familial Adenomatous Polyposis When do first degree relatives need screening How often should screening be performed

Thousands of polyps by 15y/o, Ca by 40y/o Genetic screening after 10y/o Annual sigmoidoscopy starting at 12y/o

Once Polyps are identified on colonoscopy, how often are f/u needed ? is the MCC of lower GI bleeds and how does this MC present What presentation signals this Dx is probably present

q3-5yrs Diverticulosis Painless rectal bleeding in elderly Pt w/ LLQ pain

Presence of what 3 PE finding suggest w/ Sp98% and Sn97% that diverticulitis is present How is diverticulosis Dx What image needs to be done in all Pts and what needs to be avoided

No vomiting CRP >5mg/dL LLQ tenderness CT w/out contrast: fast stranding w/ wall thickening X-ray r/o free air; Avoid colonoscopy

How much fiber is recommended when Tx constipation What are the bulk-forming laxative What are the osmotic laxatives What are the suppositories used for constipation Tx

20-25g/day Psyllium seed Methylcellulose Ca polycarbophil Dextrin Polyethylene glycol Glycerin Bisacodyl

How does Hep A transmit and w/ ? travel link How do Pts present How long are they contagious What education is given to Pt and what is given prophylactic to family

Fecal-Oral from Asia Hepatomegaly Jaundice Until 1 week of jaundice Life long immunity; IV-IGg

How does Hep B present ? lab finding suggests some form of immunity is present ? lab finding suggests an infection is present What lab result suggest acute Hep B process What lab result suggests a resolved/chronic Hep B

Flu-like and Jaundice Anti-HBs (HepBSAb) HBsAg Anti-HBc IgM Anti-HBc IgG

How does Hep C present What is the MC route of transmission What is used for screening and Dx ? risk are these Pts at for later in life

Flu-like Sxs w/ RUQ pain IVDA Anti-HCV Abs; HCV RNA quant Hepatcellular cancer

What drugs are used for the Tx of Hep C Hep D can only occur w/ ? and w/ ? differences How is Hep D transmitted

Sofosbuvir Grazoprevir Daclatasvir Hep B; more severe hepatitis and faster progression to cirrhosis Clotting factors Drug use

How is Hep E transmitted When is this form dangerous How is it Dx

Fecal-Oral waterborne outbreak Infant mortality if pregnant IgM anti-HEV

How is Hep D Tx What is used for Hep E if RNA is detected in stool/serum for >6mon Define Cirrhosis

PEG-IFN x 12mon Ribavirin Regenerative nodules surrounded by fibrotic tissue preventing regeneration

What are the two MC causes of cirrhosis ? autoimmune d/o can cause this What classic skin changes can be seen on PE

Chronic Hep C Alcohol abuse Wilson's Dz Spider angiomata Palmar erythema Caput medusa

What lab is ordered at the time of a cirrhosis Dx What screening do they need Cirrhosis Pts presenting w/ fever and abdominal pain have ? Dx

A-fetoprotein followed by MRI Abdominal US q6mon EGD Spontaneous bacterial peritonitis

# Define Budd Chiari What triad do Pts present w/ Usually ? lab ratio is seen in cirrhosis

Hepatic vein thrombosis Abdominal pain Ascites Hepatomegaly AST>ALT

? is the gold standard Dx test for cirrhosis What mortality scoring system is used How is hepatitis d/t autoimmune or Wilsons Tx

Liver biopsy Child-Pugh, 1 and 2yr survival: A: 5-6pts 100-85% B: 7-9pts 81-57% C: 10-15pts 45-35% Auto: CCS Wilson: Penicillamine

What is used for cirrhosis Pts prophylaxis against variceal hemorrhage How is cirrhosis related encephalopathy Tx How is cirrhosis related ascites Tx How is cirrhosis related pruritus Tx

Non-Selectives: Nadolol + Propranolol Lactulose + Neomycin Na restriction, centesis Cholestyramine

? tumor marker is used for liver Ca Hepatocellular Ca often occurs in setting of ? two Dxs How does Dx depend on the size of lesion

Alpha-fetoprotein Chronic liver dz Cirrhosis <1cm: MRI Neg= US q3mon

# Define Cholecystitis What PE finding aids w/ Dx Chronic cholecystitis can lead to ? condition

Inflammation of gallbladder from gallstones/obstruction Murphys- RUQ pain w/ inspiration Boas- R subscapular pain d/t phrenic nerve irritation Porcelain gallbladder, premalignant

How is cholcystitis Dx Define Cholangitis What triad can this present with and ? makes it a pentad

First: US Gold: HIDA Infected obstruction d/t E Coli ``` Charcots: Fever RUQ pain Jaundice +HOTN and Confusion ```

What bowel/bladder changes are reported during cholangitis Define Sclerosing Cholangitis This commonly occurs in Pts w/ ? Dx and presents as ?

Light stool, dark urine d/t common duct obstruction Cholestasis w/ inflammation/fibrosis or bile ducts UC; Pruritus and Jaundice

How is cholangitis Dx How is it Tx Define Cholelithiasis

RUQ US but, ERCP is optimal +Charcot and abnormal liver test: direct to ERCP ERCP for stone removal Gallstones w/out inflammation

? is the cardinal Sx of cholelithiasis How is this Dx What lab result is elevated when there is obstructed bile flow

Biliary colic RUQ US after 8hrs of fasting ALK-P

What mnemonic is used for DDxs for pancreatitis

``` GET SMASHED Gallstone Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting HyperCa Hyperlipids ERCP Drugs ```

? criteria is used to predict severity of acute pancreatitis What are poor predictors for criteria at admission How is chronic pancreatitis' presentation different

Ranson ``` Age >55y/o Leukocyte >16K Glucose >200 LDH >350 AST >250 ``` Steatorrhea, Malabsorption

What is the classic triad for chronic pancreatitis ? lab result is more specific for pancreatitis What is the Dx test of choice

Pancreatic calcification Steatorrhea DM Serum lipase 3x higher CT Xray: sentinel loops

What part of PE may clue to pancreatitis on written exams ? is the best/most important part of pancreatitis Tx What tumor marker is used for pancreatic Ca

Dec bowel sounds IV fluids CA 19-9

# Define Courvoisiers Sign What is the MC type of pancreatic neoplasm What is this type of Ca associated w/

Nontender, palpable gallbladder suggesting pancreatic neoplasm Ductal adenocarcinoma at pancreatic head Cigarette Pancreatitis Obesity DM

What PE finding suggests pancreatic cancer has spread and is inoperable How is pancreatic Ca Dx How is this Tx

Pain relieved w/ sitting forward Ct and Inc amylase ``` Whipple Procedure: Gallbladder Stomach antrum Pancreatic head Duodenal section ```

What are the 3 types of hemorrhoids How does each type present

External: distal to dentate Internal: prox to dentate Mixed: both Internal: painless, bloody w/ sensation of incomplete void External: pain, no bleeding

How are hemorrhoids graded Pts w/ anal fistulas need ? Dz considered Fistulas are usually located w/ in ? far from anal margin

1: visible, no prolapse 2: prolapse, spot reduce 3: prolapse, manual reduction 4: irreducible, can strangulate Crohns 3cm

How are anal abscesses Dx How are perianal fistulas Dx Define Kwoshiorkor

Clinical Recurrent= CT Anoscopy Deficient protein

# Define Marasumus What happens during deficient fat soluble vitamins

Deficiency of all energy forms A: night blindness D: rickets E: neuropathy K: bleeding

What happens in Thiamine deficiency What happens in Niacin deficiency What happen in Pantothenic Acid deficiency

B1- Beriberi, Wernickes, Korsakoff syndrome B3- Pellagra B5- numb/tingles

What happens in Pyridoxine deficiency What happens in folate deficiency What happens in cobalamin deficiency

B6- atrophic glossitis, siderblast anemia Neural tube defect, megablast anemia B12- megablast anemia, cord degeneration

IMC/FM/EMED GI Flashcards

(77 cards)