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Toronto Notes - GI Flashcards

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1
Q

Commonly forgotten causes of vomiting

A

Drugs, uremia, CNS disease, pregnancy

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1
Q

Differential of Abdominal Distention (6 F’s)

A

Fat, Feces, Fetus, Flatus, Fluid, Fatal growth

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2
Q

Causes of acute upper abdominal pain

A

Consider chest sources including MI, pneumonia, dissecting aneurysm

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3
Q

Intermittent abdo pain precipitated by eating

A

Obstruction (gastric outlet, small bowel), pancreatitis, ischemic bowel

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4
Q

Obscure but treatable causes of Abdo pain

A

Porphyria, angioedema, Familial Mediterranean Fever, Vasculitis (polyarteritis nodosa)

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5
Q

Most common cause of constipation

A

inadequate fiber or fluid intake

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6
Q

Retroperitoneal structures (SAD PUCKER)

A

Suprarenal glands, Aorta/IVC, Duodenum (D2-4), Pancreas (tail is intra), Ureters, Colon, Kidneys, Esophagus, Rectum

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7
Q

Which part of the small intestine absorbs Vitamin B12 and bile acids?

A

ILEUM

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8
Q

Key questions in dysphagia

A

Difficulty starting swallowing, associated symptoms (regurg, voice change, weight loss), solids/liquids/both, intermittent/progressive, hx of heartburn, change in eating habits

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9
Q

Odynophagia

A

Pain on swallowing

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10
Q

Key questions to ask in GERD

A

Dysphagia, weight loss

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11
Q

Foods that aggravate GERD

A

ETOH, caffeine, tobacco, fried foods, chocolate, peppermint, spicy foods, citrus fruit juices

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12
Q

Treatment for Non-erosive reflux disease

A

Symptom relief only; PPI PRN

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13
Q

Treatment for Esophagitis

A

Heal inflammation by PPI indefinitely or surgical fundoplication

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14
Q

What % of patients with Barrett’s esophagus do not report GERD symptoms?

A

25%

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15
Q

Gastric vs. Duodenal ulcers

A

Gastric = ALWAY BIOPSY; Duodenal = rarely malignant

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16
Q

Management of Peptic Ulcer Disease

A

Stop NSAIDS, Acid neutralization, H. pylori eradication, Quit smoking

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17
Q

Relationship of smoking with PUD

A

risk of ulcer, complications, death from ulcer, impairs healing

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18
Q

Questions to ask in Acute Diarrhea (THOSE FADS WILT)

A

Travel, Homosexual, Outbreak, Seafood, Extra-intestinal signs of IBD, FH, Abx, Diet, Steatorrhea, Weight loss, Immunosuppressed, Laxatives, Tumor hx

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19
Q

Infectious causes of Inflammatory Diarrhea (CaSaDiff Coli-EhShY)

A

Campy, Salmonella, C diff, EHEC, E histolytica, Shigella, Yersinia

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20
Q

Symptoms of Salmonella typhi

A

Rose spot rash on chest, prodrome of high fever, bradycardia, HA, abdo pain; diarrhea is not initial presentation

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21
Q

Vitamin K dependent coagulation factors

A

2,7,9,10, protein C & S

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22
Q

Gluten containing products (BROW)

A

Barley, Rye, Oats, Wheat

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23
Q

Initial presentation of ulcerative colitis

A

Non-bloody diarrhea

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24
Complications of Inflammatory Bowel Disease (ULCERATIVE COLITIS)
Urinary calculi, Liver, Cholelithiasis, Epithelial, Retardation of growth/sex, Arthralgia, Thrombophlebitis, Iatrogenic, Vitamin deficiencies, Eyes, Colorectal cancer, Obstruction, Leakage (perf), Iron deficiency, Toxic megacolon, Inanition (wasting), Strictures/fistula
25
Causes of Constipation (DOPED)
Drugs, Obstruction, Pain, Endocrine, Depression
26
Risk factors for mortality from bleeding peptic ulcer
co-morbid disease, hemodynamic unstable, Age > 60, transfusion required
27
If varices isolated to stomach, think
splenic vein thrombosis
28
When suspecting Lower GI Bleed, need to rule out
Upper GI Bleed
29
Differential for Lower GI Bleed (CHAND)
Colitis (radiation, infectious, ischemic, IBD (UC>CD)), Hemorrhoids/fissure, Angiodysplasia, Neoplastic, Diverticulitis
30
Melena vs. Hematochezia with regards to tumor localization
Melena = right; Hematochezia = left
31
Management Approach to Crohn's
Nutrition/Symptomatic (loperamide/Tylenol) --> 5-ASA/Abx --> CS --> Immunosuppression (azathioprine, 6MP, MTX) --> Immunomodulators (TNFa) --> Experimental tx/Surgery
32
Meds for induced remission for Crohn's disease
5ASA, CS, Immunosuppressive, Abx, MTX, Infliximab
33
Meds for maintenance of remission for Crohn's disease
Immunosuppressive, MTX, Infliximab
34
Meds for induced remission for Ulcerative colitis
5ASA, CS, Immunosuppressive
35
Meds for maintenance of remission for Ulcerative colitis
5ASA, Immunosuppressive
36
Forrest Classification of Peptic Ulcers
I (arterial bleeding), IIa (visible vessel), IIb (sentinel clot), IIc (hematin covered flat spot), III (no stigmata of hemorrhage)
37
Forrest Classification risk of rebleeding
I (55-100%), IIa (43%), IIb (22%), IIc (10%), III (5%)
38
Colorectal Cancer screening for average risk patients > 50 years old
FOBT q 2 years, sigmoidoscopy q 5 years, FOBT + flex sig q 5 years, barium enema q 5 years, colonoscopy q 10 years
39
When to screen for HNPCC?
Genetic testing + colonoscopy q 2 years starting at 20 years old
40
When to screen for FAP?
Genetic testing + sigmoidoscopy q 1 year starting at 10-12 years old
41
When to screen if FH of first-degree relative?
Colonoscopy q 5 years beginning at 40 years old or 10 years earlier before diagnosis of relative
42
Rectal cancer vs. colon cancer
Rectal cancer has higher recurrence rate and lower 5-year survival
43
When to refer for genetic screening for APC
Confirm FAP (> 100 colorectal adenomas), test relatives at risk
44
Amsterdam Criteria for HNPCC Diagnosis
3 relatives with colorectal cancer (1 is first degree), 2 generations, 1 case before 50 years old, FAP excluded
45
Clotting factors not synthesized by liver
Factor 8, vWF
46
Differential for serum transaminase > 1000
viral hepatitis, drugs, AI hepatitis, hepatic ischemia, common bile duct stone (rare)
47
ALT > AST
Most hepatitis
48
AST > ALT
Alcoholic liver disease
49
Signs of alcoholic hepatitis
Hx of recent ETOH, RUQ pain, AST < 300, low grade fever, mild elevated WBC
50
AST/ALT > 2
Alcoholic liver disease
51
Differential for Hepatomegaly
Congestive, Infiltrative (malignant/benign), Proliferative (infectious/inflammatory)
52
Differential for Congestive Hepatomegaly
Right HF, Budd-Chiari syndrome
53
Differential for Malignant Infiltrative Hepatomegaly
primary, secondary, lymphoproliferative, leukemia
54
Differential for Benign Infiltrative Hepatomegaly
fatty liver, cysts, hemochromatosis, extramedullary hematopoiesis, amyloid
55
Differential for Infectious Proliferative Hepatomegaly
viral, TB, abscess, echinococcus
56
Differential for Inflammatory Proliferative Hepatomegaly
granulomas (sarcoid), histiocytosis X
57
Risk of developing HBV, HCV, HIV from needle puncture
HBV (30%), HCV (3%), HIV (0.3%)
58
Without treatment, what % of HBV go on to develop cirrhosis
8-20%
59
Clinical manifestations of Wilson's disease (ABCD)
Asterixis, Basal ganglia degen (suspect if Parkinson's in young), Ceruloplasmin decrease, Cirrhosis, Corneal deposits (KF ring), Copper, Dementia
60
What is penetrance of hemochromatosis?
Not 100%; not all with homozygous will have clinical iron overload
61
Esophageal Complications from ETOH Abuse
Mallory-Weiss tear, Esophageal varices (from portal HTN)
62
Stomach complications from ETOH abuse
ETOH gastritis
63
Pancreas complications from ETOH abuse
acute/chronic pancreatitis
64
Liver complications from ETOH abuse
ETOH hepatitis, fatty liver, hepatic encephalopathy; Cirrhosis --> portal HTN, ascites, HCC
65
Usual causes of death in cirrhosis
renal failure (hepatorenal syndrome), sepsis, GI bleed, HCC
66
Cirrhosis Complications (VARICES)
Varices, Anemia, Renal failure, Infection, Coagulopathy, Encephalopathy, Sepsis
67
Signs of Portal Hypertension
Esophageal varices, melena, splenomegaly, ascites, hemorrhoids
68
Management of portal hypertension
B-blockers, nitrates, transjugular intrahepatic portosystemic shunt (TIPS)
69
Precipitating factors for Hepatic Encephalopathy (HEPATICS)
Hemorrhage in GIT/Hypokalemia, Excess dietary protein, Alkalosis/Anemia, Trauma, Infection, Colon surgery, Sedatives
70
Secondary bacterial peritonitis due to
perforated viscus, surgical manipulation
71
Gilbert vs. Crigler Najjer in reduced glucuronyltransferase activity
Gilbert = mild decrease; Crigler Najjer = complete deficiency
72
PBC vs. PSC on ERCP
PBC = absence of narrowing; PSC = narrowing of intra/extrahepatic ducts
73
Charcot's Triad for Ascending Cholangitis
RUQ pain, Fever, Jaundice
74
Reynold's Pentad for Ascending Cholangitis
RUQ pain, Fever, Jaundice, Hypotension, Confusion
75
Pancreatic enzymes
Amylase, lipase, trypsin, chymotrypsin
76
If serum amylase > 5 times normal
Almost always pancreatitis or renal disease
77
Differential for Acute Pancreatitis (I GET SMASHED)
Idiopathic, Gallstones (45%), ETOH (35%), Tumors, Scorpion sting, Micro, AI, Surgery/trauma, Hyperlipid/Hypercalcemia/Hypothermia, Emboli/ischemia, Drugs/toxins
78
What is Ranson's Criteria?
Prognostic indicator or mortality in pancreatitis not due to gallstones
79
Ranson's Criteria at admission (BALAW)
BG > 11 mmol/L, Age > 55, LDH > 350, AST > 250, WBC > 16
80
Ranson's Criteria at 48 hours (CHOBBS)
Ca < 2, Hct drop > 10%, PaO2 < 60, Base deficit > 4, BUN rise > 1.8, Fluid sequestration > 6 L
81
Prognosis based on Ranson's Criteria
2 = difficult course; > 3 = high mortality
82
Symptoms of Chronic pancreatitis
Abdo pain, diabetes, steatorrhea
83
Etiology of chronic pancreatitis (AAA)
Almost Always Alcohol
84
Treatment of chronic pancreatitis
ETOH abstinence, enzyme replacement, analgesics, resection if duct blockage
85
What is initial sign of short bowel syndrome?
Low Magnesium
86
Most common indications for TPN
Pre-existing nutritional deprivation, inadequate intake by mouth, significant multiorgan system disease

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