Gastrointestinal - 9% Flashcards

Question

Cholelithiasis dx, tx

Answer 1

**Gold - RUQ US** \> 2mm 3 types deps on color (yellow for cholesterol black - hemolysis, ETOH, cirrhosis brown - biliary tract infx observation if asymp Tx - Urseodeoxycholic acide to dissolve GS Elective cholecystectomy

Answer 2

Gallstones + pain when GB compresses on GS Fat Forty Fertile Female Flatulence Sxs: * MC asymp Biliary colic * episodic RUQ/epig pain —\> resolves in 30-1h * **post prandial pain** + at night

Answer 3

Pancreaticojejunostomy -\> Whipple PO Pancreatic enzyme replacement ETOH abstinence Pain control

Answer 4

**Colonoscopy with bx - gold** barium enema - **apple core lesion** + CEA - marker CBC - anemia

Answer 5

3rd MC Cancer in US Genetics Familial Adenomatous Polyposis (APC gene - develop colon cancer by 40yo —\> prophylactic colectomy RFs * age \> 50yo - * UC \> Crohn's - * Low fiber diet - * smoking - * etoh - * AAs - * fam hx of CRC

Answer 6

average risk * start at 50 yo * FOBT q 1 year * Colonoscopy q 10y or Flex sig q 5 y 1st degree Relative or high RFs * FOBT q1y * starting at 40y or 10 yrs younger than earliest dx age Colo - q 5y Highest risk * UC or Crohn's \>8yrs, * FAP * FOBT any age * Colonoscopy q5y

Answer 7

MCC large bowel obstruction in adults Painless rectal bleeding; changes in bowel habits **Right sided - ascending colon** * proximal - lesions tend to bleed * occult blood loss = anemia/+ FOBT * non-spec sxs - fatigue, wt loss **Left sided - descending colon** * changes in bowel habits - constipation * sxs of obstructions; present later * abd pain, N/V, distention

Answer 8

localized (stage 1 to 3) - resection Stage 3 to Mets - chemotherapy with 5FU/Fluorouracil

Answer 9

Inflammation of colon d/t C. Diff 2/2 abx penicillin, cephalosporins, FQ disrupts normal colonic flora Sxs * Mild watery foul smelling diarrhea (\>3 but \< 20 stools/d) * Fever * Abd pain, gen constitutional sxs Dx * PCR - C diff toxin- Toxin B (clinically important) * Stool culture * Leukocytosis Tx * IV metronidazole, or PO Vanc * Strict hand washing * Complications - bowel perf/ toxic megacolon

Answer 10

**gold - CT scan** FOBT + CBC Leuks Tx: * Abx - Cipro/Bactrim + MNZ * Clear liquid diet * colonoscopy in 6 wks to r/o cancer

Answer 11

Infection and inflammation of outpouchings d/t fecalith Sxs: * LLQ abd pain * Fever N/V/D * Constipation * bowel changes and bloating

Answer 12

CT - TOC\*\*\* * avoid barium enema Tx: * high fiber diet * psyllium - fiber supplement

Answer 13

Outpouchings d/t intestinal mucosa herniation Sxs: * **MCC BRBPR** * Low fiber diet * LLQ discomfort * fever, chills

Answer 14

MCC esophageal ca in US - White Males **a/w Barrett's esophagus and GERD; lower 1/3 of esophagus** Sxs: * progressive dysphagia solids -\> fluids odynophagia * chest pain not related to eating * reflux hoarseness Dx - Endoscopy with Bx - gold Barium; esophagram CT for staging Tx - Esophageal resection chemo 5FU

Answer 15

MCC Esophageal worldwide; 50-70yo; **a/w smoking/etoh** **upper 2/3 of esophagus** **Dx - Endoscopy w/ bx and diagnosis** Chemo or radiation or resection

Answer 16

Strictures - scarring from healing process of ulcerative esophagitis **_Schatzki Ring_** - diaphragm mucosal ring that causes sxs if is too small. Sxs * solid food dysphage w/ hx of GERD Dx * Barium swallow/ esophagram * Endoscopy is confirmatory Tx * Endoscopy and dilatation * sx rarely needed

Answer 17

Dilated submucosal veisn in distal esophagus or proximal stomach hx of portal HTN & Cirrhosis; high mortality Sxs: * Hematemesis - coffee ground appearance * melena -black tarry stool * VS instability * hypovolemia/tachycardia * shock Dx: * Emergent endoscopy (EGD) * **Band ligation\*\*\*\* & IV Ocreotide for vasoconstriction** * sclerotherapy * If fails - Balloon tamponade or TIPS (transjugular intrahepatitc portosystemic shunt) * Longterm - **BB (propanolol**), no etoh

Answer 18

Inflammation of small bowel 2/2 ingestion of gluten; autoimmune disorder, hereditary Sxs * Diarrhea, steatorrhea, flatulence, weight loss * weakness and abd distention * infants/children = FTT Dx * **IgA antiendomysial (EMA)** and **antitissue Transglutaminase (anti-tTG) abs** * **Endoscopic intestinal mucosal biopsy of** proximal and distal duodenum- confirmatory Tx - GF Diet

Answer 19

Inability to digest lactose - predom sugar of milk, via lack of lactase Sxs * abd bloating and cramps, flatulence * diarrhea, N, borborygmi, vomiting * usu 30mins to 2 hrs Dx * **Lactose breath hydrogen test** - positive if \> 20ppm * **Stool acidity test (fecal pH test)** - acidic = acid producing bacteria Tx * avoid dairy product * lactase supplement

Answer 20

linked to anaphylaxis Sxs/ Dx * Derm - pruritis, erythema, urticaria, angioedema * GI manifestation - N/V, abd cramps, diarrhea * Anaphylactic reaction - respiratory syst and can be fatal * Cutaneous manifestation - angioedema, urticaria Avoid nuts, and nut products administer **epinephrine** asap

Answer 21

MC adenocarcinoma; can be _lymphoma (rarer, a/w Non Hodgkin Lymphoma)_ RFs: * **H pylori\*\*\*** salted, cured, pickled food * Etoh, Smoking * Blood type A **_WEAPONS_** * Weight loss + Fe deficiency Anemia * Emesis * Anorexia * Pain/abd discomfort * Obstruction * Nausea Dx * Endoscopy with Biopsy - Linitis plastica - thickening of gastric wall Tx - poor prognosis- resection

Answer 22

Virchow's Node - Left supraclavicular LN Sister Mary Joseph's Nodule - umbilical LN

Answer 23

Relaxation of LES Sxs: * Heartburn\* w/ meals, wt gain, N, recumbency * Throat irritation and cough Tx - symptom relief w/ PPO and H2 Blockers * **PPI - sx relief + promote healing** * Tx empircally on PPI x 4 wks (failed H2blockers w/ mod-severe GERD) Dx * **Endoscopy - if failed empirical tx on PPI OR** * GI bleeding/anemia * Dysphagia/odynophagia * unintentional wt loss * H/o heavy NSAIDs * Risk of UGI cancers

Answer 24

Dx * **Urea Breath test \* gold** - needs to be off PPI, bismuth and abx * active infection * urea as byproduct of metabolism * **Stool antigen** * Endoscopy bx Tx * **Clarithromycin 500 mg BID** * **Amoxicillin 1g BID** * **PPI BID** * Metronidazole 500 mg if pcn allergic * Follow up with **_urea breath test 1 mo post tx_** to ensure eradication

Answer 25

Burning pain or discomfort - after eating at night, worsen when lying down GERD * Acid reflux + HB \> 2x/wk = GERD Food Intolerance Esophagitis * painful, difficulty swallowing + CP w/ eating Gastritis * H. pylori or NSAIDs, or etoh Hiatal hernia * no sxs but can be a/w HB and abd discomfort PUD * burning abd pain, N/V, bloating

Answer 26

varicose vein of anus and rectum RFs - constipation/straining, pregnancy, portal HTN Dx - **Anoscopy** if BRBPR or suspected thrombosis _External_ * lower 1/3 of anus * thrombosed * significant pain, pruritis, NO bleeding * palpable perianal mass w/ purplish hue * Tx - **excision** _Internal_ * upper 1/3 of anus * BRBPR, pruritis, rectal discomfort * Tx - Fiber, sitz bath, ice packs, stool softeners * Rubber band ligation - if +protrudes, enlargement and intmt bleeding * Hemorrhoidectomy if prolapse

Answer 27

**Alpha fetoprotein (AFP)** marker esp in pst with hep C or cirrhosis **Ultrasound**, MRI lesions \>/= 1cm Liver transplant for * single lesion \< 5cm or * = 3 lesions that are all = 3cm Surgical resection - cancer can recur

Answer 28

Primary Cancer - HCC 2/2 to mets from lungs and breast Ca (MC) RFs: * Hepatitis B, C, D * Cirrhosis * Aflatoxin B1 exposure (Aspergillus spp) Sxs * Malaise, wt loss * Jaundice, ascites, Hepatosplenomegaly

Answer 29

Protrusion of organ/structure through abd wall **Inguinal hernias** * MC - through internal ring down the inguinal canal (into scrotum) **Direct inguinal hernias** * passage of intestines through external inguinal ring at Hesselbach's triangle Sxs: * Reducible bulge when patient coughs or strains * Usu painless unless 1. Incarcerated - can't be reduced 2. Obstructed - irreducible hernia but no interference w/ blood flow 3. Strangulated - blood supply cut off - bowel ischemia, necrosis perforation Tx - Open repair or lap w/ mesh reinforcement

Answer 30

**_Femoral_** - into groin at the top of inner thigh **_Incisional_** - a/w vertical incisions - esp with obesity

Answer 31

**_Sliding hernia (type 1)_** - \>90% cases, GE junction and portion of stomach herniates into thorax through esophageal hiatus (GE junction above diaphragm) **_Paraesophageal Hiatal Hernia (type 2)_** - \<5% cases . Stomach herniates into thorax through esophageal hiatus, but GE junciton does not. Remains below diaphragm. * can become strangulated Sxs * heartburn, chest pain, dysphagia Dx * Upper GI series, endoscopy Tx * Type 1 - antacid, small meals, ele of head after meal - can do Nissen fundoplication * Type 2 - elective surgery

Answer 32

Genetic +environmental factors; peaks at 15-35 yo Mouth to anus - transmural, "**Skip lesions"** Sxs: * Colicky RLQ pain * Diarrhea/ malabsorption * Low grade fever * Wt loss * a/w anal fistulas, aphthous ulcers Dx: * Colonoscopy - gold * **cobblestoning** * **skip lesions** * small bowel films * **string sign - barium study** * Lab - CBC, ESR, CRP, B-12, stool culture * **+ASCA**

Answer 33

Idiopathetic, inflammatory dz Friable **mucosa and submucosa**, limited to colon = **Rectum MC** bimodal distr - 15-25yo and 55-65 Sxs: * Bloody, pus filled diarrhea * LLQ pain * fever Dx: * Barium enema - **lead pipe appearance** * **coloscopy with bx** - gold = loss of haustral markings and lumen narrowing * risk of toxic megacolon * **pANCA**

Answer 34

Medical Management _5-Aminosalicylates ASA_ * **Mesalamine** * SE - NV, HA, rash, fever * replace folic acid * **Sulfasalazine** _Immunomodulators_ * **Azothioprine/6-mercaptopurine** * maintenance therapy * takes 3-6 mos for full effect * can come off 5ASA * check LFTs and CBC q 90 ds Biologics * TNF-inhibitors (Infliximab/Remicade, Adalimumab/Humira) * SE - reactivate of Hep B and TB (check prior to initiation) * expensive _Corticosteroids_ * high dose, short course =\> acute exacerbations * Prednisone in taper 30-40mg _Abx - for fistula_ * Metronidazole * Cipro * Rifaximin

Answer 35

Causes of Diarrhea - infectious, toxic, dietary, or other GI diseases * Traveler's Diarrhea - E coli * Picnic and egg salad - S aureus * Shellfish - Vibrio cholera * Poultry or pork - Salmonella * Pt post abx - C diff * poorly canned home foods - C perfringens * Breakout in a daycare center - Rotavirus * Cruise ship - Norovirus * Fresh mountain stream water - Giardia lamblia - foul smelling bulky stool

Answer 36

MC in IMC hosts; Sxs: * **Odynophagia\*** (painful swallowing) - food or liquid * Dysphagia (difficult swallow) * Chest/substernal pain/fever Dx/Tx - EGD * **Candida MC** - linear yellow white plaques * Fluconazole 100 mg PO QD * HSV - shallow punched out lesions * Acyclovir * CMV - large solitary ulcers or erosions * Ganciclovir Tx - EGD dilation

Answer 37

Intestinal obstruction; part of bowel telescopes into nearby segment MC in children 3mos to 6yo; MC a/w adenovirus Sxs * Severe, **colicky abd pain** =\> lethargy * Abd mass - **sausage shaped** * **bilious emesis**, stool with mucus or blood (**currant jelly**) * decr stool if obstruction + Dx * **abd US\*\*** gold = telescoping Tx * **Air/Contrast enema** * Surgery if + free air under diaphragm, peritonitis, hemodynamic instability

Answer 38

Bilirubin deposition = hyperbilirubinemia 1st sign - scleral icterus; serum bilirubin \> 2.5mg/dl _pathophys_ * RBC breakdown = globin + Heme =\> iron + protoporphyrin * unconjugated bilirubin +albumin -\> liver + **uridine glucuronyl transferase (UGT) = conjugated bilirubin** * Conjugated BR =\> bile formation in GB Eti: **_Unconjugated Bilirubinemia - no acholic stools, jaundice_** **Extravascular hemolysis, ineffective erythropoiesis** **Physiological jaundice of newborn** * can lead to kernicterus, neuro deficits and death = tx w/ phototherapy **Gilbert Syndrome** * mildly low UGT increases UCB = jaundice during physio stress- fasting **Crigler-Najjar Syndrome** * RARE - toxif levels of indirect bilirubin - Jaundice at birth\* * abs of UGT = incr UCB = kernicterus **_Conjugated Bilirubinemia - Direct - usu d/t obstruction, jaundince, acolic stools_** **Dubin-Johnson Syndrome - opps of Gilberts** * deficiency of bilirubin canaliculi = incr CB * liver is pitch dark * Rare benign - seen in pregnancy, etoh, OCP use * Jewish descent **Biliary Tract Obstruction** * gall stones, pancreatic carcinoma, liver fluke, cholangiocarcinoma **Viral hepatitis**

Answer 39

Mucosal tearing of gastroesophageal junction from vomiting Sxs: * Hx of vomiting/retching or alcohol intake * **PainLESS** hematemesis Dx - Esophagogastroduodenoscopy (EGD) Tx - self limited, supportive

Answer 40

Hypoperfusion to bowel vasculature Sxs: * abd pain OOP to PE * h/x of afib, vascular dz Dx - CT angio, treat in surgery

Answer 41

X linked Recessive; Hemolytic anemia d/t oxidative stress = 2-4d post exposure Sxs: * Patient taking antimalarials, sulfonamides, nitrofurantoin, Fava beans * Malarial protection Dx * Peripheral blood smear - **Heinz bodies** * Results in **bite cells** Tx * self limited, maintain hydration * severe anemia - iron/folic acid supp

Answer 42

Incr in osteocastic activity, then incr in osteoblastic activity Sxs * Asymp MC * arthritis, pain = vertebral involvement =\> stenosis, nerve compression * bone deformity, fracture Dx * **ele alk phos**; normal Ca, Normal phosphorus * X-ray - **bone thickening, enlarge thickened cortices\*\*** Tx * Bisphosphonates

Answer 43

MC autosomal recessive; lack of amino acid phenylalamine hydroxylase protein to convert into Tyrosine **Newborn screening 2-3 days after birth** Sxs * **musty urine or body odor,** microcephaly * mental or growth retardation Dx * decr phenylalanine hydroxylase =\> **incr phenylalanine** and **decr tyrosine** Tx * Avoid phenylalanine in diet = no beef, pork, chicken * limit carb * Lots of fruits and vegetables - tyrosine * Nutritional supplements

Answer 44

Softening and weakening of bones d/t **lack of Vitamin D;** defective mineralization of cartilage in epiphyseal growth plates MCC- insufficient intestinal absorption RFs - little sun exposure, darker pigmente skin, BF'ing w/o vit D supplementation Sxs * Bowed legs, stunted growth, bone pain * Large forehead, trouble sleeping * Bone frx, muscle spasms, abn curved spine or intellectual disability Dx * AP Radiographs of Knees and Wrist - Osteopenia, metaphyseal cupping, distal physis widened * Labs - ****↓ **25-hydroxyvitamin D,** * ****↓ calcium, ↓ phosphate * ↑ alkaline phosphatase, ↑ parathyroid hormone levels Tx * Vitamin D supplementation = maintain target of **\> 20 ng/mL** * Breastfed infants = **400 IU or 10 mcg daily** of Vit D supp, few days after birth * Children 1-18 yo = **600 IU or 15 mcg daily**

Answer 45

1. Reflux Esophagitis * mechanical or functional abn from LES - refer to GERD 2. Medication induced * Usu NSAIDs or bisphosphonates - drink 4oz of water, sit upright 3. Eosinophilic - allergic eosinophilic infiltration of esophageal epithelium * dx w/ **Barium swallow = ribbed esophagus and multiple corrugated rings**

Answer 46

Bowel Obstruction - small and large Small Bowel Intussusception Ileus **_Gastroparesis_** * condition that affects stomach muscles, prevents proper emptying * MCC - DM, anorexia/bulimia, scleroderma, Ehlers-Danlos, abd surgery * N, early satiety, palps, HB, bloating * Dx - KUB, manometry, gastric emptying scan * Tx - Lower fiber and low residue diet, small meals * Metoclopramide

Answer 47

**MCC smoking\***, chronic pancreatitis, ETOH, DM, M, obesity, AA Adenocarcinoma - ductal, and **head of pancreas MC** Sxs: * MC metasis at dx - regional LN or liver * Abd pain =\> back * **painless jaundice\*** classic - 2/2 common bile duct obstruction * Wt loss * **Pruritis** - incr bile salts, **acholic stools/dark urine** * **Courvoisier's sign** - palpable, NT, distended GB a/w jaundice Dx * **CT scan - initial TOC** * **CA 19-9** tumor markers Tx * **Whipple procedure** * Advanced or inoperative * ERCP w/ palliative stent for itching

Answer 48

Cystic collection of tissue, fluid, & necrotic debris surrounding the pancreas. Wall is from **inflammatory fibrosis, not epithelial lining** a/w - chronic pancreatitis, occurs 2-3 wks after acute pancreatitis, trauma to chest (steering wheel trauma) Sxs * Abdominal pain * hx of chronic pancreatitis Dx * **CT\*\* - TOC** * US * elevated amylase/lipase * Bilirubin, CBC Tx * if persists 4-6 wks, or enlarges * Percutaneous drainage \> 5cm * Surgical decompression - **pancreaticogastrostomy** * Cystic fluid - drained into stomach or bowel

Answer 49

MCC of non hemorrhagic GI bleeds Duodenal 5x \> Gastric; MCC H pylori \> NSAIDs, ETOH, smoking Sxs: * **_Gastric Ulcers_** * abd pain worse with meals - get better after eating * patient refuses to eat (losing weight) * **_Duodenal Ulcers_** * Pain gets better with eating - worse after eating * Patient gaining weight * hemorrhage from _gastroduodenal artery_ * MC than gastric ulcer\* Dx * **Endoscopy\* - gold** Tx * PPI qd-BID x 8 to 12 weeks; confirm EGD w/ gastric ulcer healing

Answer 50

Hypertrophy and hyperplasia of muscular layers of pylorus = functional outlet obstruction Infants, first 2-3 wks of life or \< 3mos Sxs * **projectile vomiting** * **non bilious** after every feed * DeH2O - **hypochloremic, hypokalemia, metabolic alkalosis** * palpable **olive mass** in epigastric region Dx * **US - double track sign** * **Barium study - string sign** Tx * IV fluids rehydration * Pyloromyotomy - Ramstedt procedure

Answer 51

Rare, delay in dx common MC **adenocarcinoma**, highest in duodenum.; RF - hereditary nonpolyposis colorectal ca, CF, Crohns Sxs: * Abdominal pain - intermittent and crampy * N/V, wt loss, jaundice, Anemia * Obstruction \> perforation Dx * CT * Screen for FOBT, LFTs, CBC * some +CEA Tx * Surgery - localized * Adjuvant chemo for LN+

Answer 52

Non obstructive, extreme **colonic dilation \> 6cm + signs of systemic toxicity** Eti - Crohns, UC, infection, radiation Sxs: * fever, abd pain, N/V * tenesmus * rigidity, tachycardia, dehydration, hypotension, AMS Dx * Abd radiographs - **large dilated colon \> 6cm** * 3 of the following * Fever \> 101.5 * HR \> 120 bpm * Neutrophilic leukocytosis \>10.5 x 10^9 * Anemia Tx * **bowel decompression** * Bowel Rest, NG tube, broad spectrum abx * Colostomy reserved for refractory cases

Answer 53

False outpouching in posterior hypopharynx - uncoordinated swallow/occlusive ep Sxs * Dysphagia, choking, cough, **halitosis\*\*** * aspiration, **regurgitation of undigested** food * aspiration pna or bronchiectasis Dx * Barium esophagram * EGD - Contrast CT of neck Tx * Surgical if severe

Answer 54

Gastrinoma of _pancreas\*_ or duodenum PUD develops in 90% of pts Consider if * **_Recurrent PUD_** * **_Neg H. pylori, Neg NSAID/ASA use_** * Severe abd pain, diarrhea Dx * **secretin test =\> gastrin level will rise** Tx * Surgical resection of gastrinoma

Gastrointestinal - 9% Flashcards

(78 cards)