GI Flashcards Preview

CDB PEARLS > GI > Flashcards

Flashcards in GI Deck (210):
1

UC vs CD: Involves the rectum

UC

2

UC vs CD: Rectal sparing

CD

3

UC vs CD: Bimodal age of onset

UC

4

Ethinicity least affected by UC

Asians

5

Male to female ratio of UC and CD

Approximately equal

6

Effect of smoking on UC

May prevent disease

7

Effect of appendectomy on UC

Protective

8

UC vs CD: Pseudopolyps

UC

9

UC vs CD: Toxic megacolon

UC

10

Characteristic finding in UC described as villous atrophy and crypt regeneration with increased inflammation

Backwash ileitis

11

Criteria for IBS

Change in bowel habits lasting for 6 months without identifiable cause

12

Type of diarrhea seen in UC

Nocturnal

13

Important features of severe UC

1) Fever
2) Elevated ESR
3) Ulcerations

14

UC endoscopically described as fine granularity

Mild UC

15

UC endoscopically desrcibed as having coarse granularity with no ulcerations

Moderate UC

16

Complications of UC

1) Massive haemorrhage
2) Toxic megacolon
3) Perforation
4) Strictures

17

Segment of colon affected in toxic megacolon of UC

Transverse or right colon

18

Diameter of toxic megacolon

>6cm

19

Most dangerous complication of UC

Perforation

20

Perforation in UC is most commonly due to

Megacolon

21

Finding in UC associated with HIV infection

Proctitis

22

T/F A colonic stricture is always presumed to be malignant unless proven otherwise

T

23

Type of polyps in UC that increases the risk for cancer

Post-inflammatory pseudopolyps

24

Extrainstestinal manifestations of UC

1) Erythema nodosum
2) Pyoderma gangrenosum
3) Ankylosing spondylitis
4) Anterior uveitis/iritis
5) Primary sclerosing cholangitis

25

UC vs CD: Abdominal mass

CD

26

UC vs CD: Fistulas

CD

27

UC vs CD: Response to antibiotics

CD

28

UC vs CD: Recurrence after surgery

CD

29

UC vs CD: ANCA-positive

UC

30

UC vs CD: Cobblestoning

CD

31

UC vs CD: Granuloma on biopsy

CD

32

UC vs CD: Entire GIT

CD

33

Highly selective marker for intestinal inflammation

Fecal lactoferrin

34

Earliest radiologic change in UC

Fine mucosal granularity

35

Ulcers seen in UC

Collar-button ulcers

36

UC vs CD: Increased pre sacral and perirectal fat

UC

37

Pharmacologic treatment for both CD and UC

Sulfasalazine

38

UC vs CD: Risk for colon CA

Both

39

Most common site of CD

Ileocecal area

40

UC vs CD: Skip leasions

CD

41

Earliest lesion seen in CD

Aphthous ulcer

42

Hallmark of CD

Focal transmural inflammatory process

43

Pathognomonic of CD

Creeping fat or fat wrapping

44

Histologic hallmark of CD

Noncaseating granuloma

45

Histologic feature that differentiates Tb from CD

Caseation

46

First line test for CD

CT enterography

47

Seen in radiograph of CD

String sign

48

UC vs CD: ASCA +

CD

49

T/F: Colon CA prophylaxis is an indication for surgery in CD

T

50

Surgery of choice for CD

Ileal pouch anal anastomosis (IPAA)

51

Most frequent complication of IPAA

Pouchitis

52

T/F Acute pancreatitis is reversible

T

53

Leading cause of acute pancreatitis

Gallstones

54

2nd most common cause of acute pancreatitis

Alcohol

55

Enzyme released in acute pancreatitis: Responsible for necrosis of fat

Lipase and phospholipase

56

Enzyme released in acute pancreatitis: Responsible for destruction of pancreatic parenchyma

Proteases

57

Enzyme released in acute pancreatitis: Responsible for destruction of blood vessels and subsequent interstitial hemorrhage

Elastase

58

Acute pancreatitis occurs in 5-20% of patients following this procedure

ERCP

59

Blue discoloration in the periumbilical region seen in acute pancreatitis

Cullen's sign

60

T/F: Fever in acute pancreatitis is high grade

F

61

Lung finding in acute pancreatitis

Basilar rales

62

Cardinal symptom of acute pancreatitis

Abdominal pain

63

Basilar rales in acute pancreatitis is most commonly appreciated on which lung

Left

64

Blue-red-purple or green-brown discolouration of flanks seen in acute pancreatitis

Grey-Turner sign

65

Cullen's sign is due to

Hemoperitoneum

66

Grey Turner sign is due to

Catabolism of hemoglobin

67

Acute necrotizing vs hemorrhagic pancreatitis: More severe

Acute necrotizing

68

Acute necrotizing vs hemorrhagic pancreatitis: Most severe

Hemorrhagic

69

Acute necrotizing vs hemorrhagic pancreatitis: Red-black hemorrhage and chalky fat necrosis

Acute necrotizing

70

Acute necrotizing vs hemorrhagic pancreatitis: Extensive parenchymal necrosis accompanied by dramatic hemorrhage within substance of gland

Hemorrhagic

71

Majority of islets of Langerhans are found on which part of the pancreas

Tail

72

Majority of pancreatic CA are found on which part of pancreas

Head

73

Insulinomas and glucagonomas are most frequently found on which part of the pancreas

Tail

74

Percentage of cells that must be destroyed to cause DM

>70%

75

Earliest enzyme that elevates in acute pancreatitis

Amylase

76

Most specific enzyme for acute pancreatitis

Lipase

77

Amylase levels typically return to normal levels after ___ of acute pancreatitis

48-72h

78

Complications of chronic pancreatitis (2)

1) Pancreatic pseudocyts
2) Malabsorption

79

Endocrine vs exocrine pancreas: Destroyed in chronic pancreatitis

Both

80

Most common cause of chronic pancreatitis in adults

Long-term alcohol abuse

81

Most common cause of chronic pancreatitis in children

Cystic fibrosis

82

Diagnostic test for chronic pancreatitis with the best sensitivity and specificity

Secretin

83

Pancreatic grading: Normal pancreas

Grade A

84

Pancreatic grading: Focal or diffuse enlargement, irregular contour, in homogenous enhancement

Grade B

85

Pancreatic grading: Peripancreatic inflammation

Grade C

86

Pancreatic grading: Intra- or extra pancreatic fluid collections

Grade D

87

Pancreatic grading: 2 or more large collections or gas in the pancreas or retroperitoneum

Grade E

88

Elevation in serum amylase required for diagnosis of acute pancreatitis

3-fold or greater

89

Diagnosis of acute pancreatitis requires 2 of the following

1) Typical abdominal pain
2) 3-fold or greater elevation in serum amylase
3) Elevated serum lipase
4) Confirmatory cross-sectional abdominal imaging

90

Criteria for severity of acute pancreatitis

1) At least 1 organ failure
2) GI bleeding >500mL/24h
3)Local complication

91

Components of BISAP score

1) BUN >25
2) Impaired mental status
3) SIRS
4) Age >60
5) Pleural effusion on radiography

92

Presence of ___ of BISAP factors is associated with substantially increased risk for in-hospital mortality

3 or more

93

Risk factors for severity of acute pancreatitis

1) Age >60
2) BMI >30
3) Comorbid disease

94

Markers of severity within 24 hours of acute pancreatitis

1) SIRS
2) Hct >44%
3) BISAP
4) Organ failure

95

Signs of organ failure in acute pancreatitis

1) CV: SBP less than 90, HR > 130
2) PaO2 less than 60 mmHg
3) Serum crea > 2 mg/dL

96

Markers of severity during hospitalization

1) Persistent organ failure
2) Pancreatic necrosis
3) Hospital-acquired infection

97

T/F Most patients with acute pancreatitis have self-limited disease

T

98

Ligament of Treitz is aka (2)

1) Hepatoduodenal ligament
2) Suspensory ligament of duodenum

99

Most common site of duodenal ulcer

First portion, within 3 cm of pylorus

100

Duodenal vs gastric ulcer: Sharply demarcated

Duodenal

101

Most common vessel eroded in duodenal ulcer

Gastroduodenal artery

102

Most common site for benign gastric ulcer

Distal to junction of antrum and gastric secretory mucosa

103

Longitudinal esophageal tears

Mallory-Weiss tears

104

Most common location of Mallory Weiss tears

Near GEJ

105

Most common risk factor for Mallory Weiss tears

Alcoholism

106

Management for active bleeding

Endoscopic therapy

107

Complication of duodenal ulcer

Pancreatitis

108

Complication of gastric ulcer

Penetration into left hepatic lobe

109

Type of perforation in which ulcer bed tunnels into adjacent organ

Penetration

110

Most common complication of PUD

Bleeding

111

2nd most common complication of PUD

Perforation

112

T/F Gastric perforation may be managed non-surgically

F

113

Surgical procedure done to repair gastric perforation

Graham omental patch

114

DU vs GU: Exacerbated by fasting, improved with meals

DU

115

Most common cause of death in PUD

Decompensation from underlying illness

116

Independent predictors of rebleeding and death in patients hospitalized with UGIB

1) Increasing age
2) Comorbidities
3) Hemodynamic compromise

117

Most common cause of UGIB

Ulcers

118

Melena indicates that blood has been in the GIT for at least

14h

119

Melena indicates that blood has been in the GIT for as long as

3-5 days

120

UGIB vs LGIB: Hematochezia with hemodynamic instability

UGIB

121

UGIB vs LGIB: Hematochezia with dropping Hgb

UGIB

122

UGIB vs LGIB: Hyperactive bowel sounds

UGIB

123

UGIB vs LGIB: Elevated BUN

UGIB

124

Tachycardia and hypotension represents blood loss of ___%

20

125

T/F: NGT aspirate is always bloody in UGIB

F

126

Most common causes of small intestinal bleeding in adults (3)

1) Vascular ectasia
2) Tumor
3) NSAID-induced erosions

127

Most common cause of significant LGIB in children

Meckel diverticulum

128

Characteristics of diverticular bleeding

1) Abrupt
2) Painless
3) Sometimes massive
4) Often from the right colon

129

T/F Diverticular bleeding is characterized by minor and occult bleeding

F

130

When fall in hgb is expected with acute GI bleeding

Up to 72h

131

Procedure of choice for diagnosis of UGIB

Endoscopy

132

High-risk endoscopic findings

1) Varices
2) Active bleeding vessel
3) Visible vessel

133

Low-risk lesions

1) Clean-based ulcer
2) Non-bleeding Mallory-Weiss tears
3) Erosive or hemorrhagic gastropathy

134

Colon CA screening

1) 25 y/o if with family member with HNPCC by colonoscopy
2) 40 y/o if with 2 2nd degree relatives with colorectal CA by FOBT
2) 50 y/o if with average risk by FOBT
3) 60 y/o if with 1st degree relative with colorectal CA

135

Refers to persistent or recurrent GI bleeding for which no source has been identified by routine endoscopic and contrast x-ray studies

Obscure GI bleeding

136

Initial test for massive obscure GI bleeding

Angiography

137

Diagnostic modality for Meckel's diverticulum especially in young patients

99mTc-pertechnetate scintigraphy

138

Most episodes of recurrent bleeding in PUD occur within

3 days

139

Therapeutic modality that decreases high risk ulcer characteristics/active bleeding if administered at presentation

PPI

140

T/F Mallory-Weiss tears stop spontaneously

T

141

Endoscopic therapy of choice for esophageal varices

Ligation

142

Therapy recommended with cirrhosis presenting with UGIB

Antibiotic treatment (ceftriaxone)

143

Disease endoscopically visualised as sub epithelial haemorrhages and erosions

Gastritis

144

Most important risk factors for gastritis

1) NSAID
2) Alcohol
3) Stress

145

Most common primary malignancy of liver

Hepatocellular carcinoma

146

Hepatocellular carcinoma: Male vs female

M

147

Biologic toxin that can cause hepatocellular CA

Aflatoxin B1 from aspergillus

148

T/F NAFLD/NASH is a risk factor for hepatocellular CA

T

149

Regulatory element in HBV genome that is a transcriptional activator of many genes

X protein

150

Most common symptom of hepatocellular CA

Abdominal pain

151

Most common physical sign of hepatocellular CA

Hepatomegaly

152

Abdominal pain in hepatocellular CA is due to

Stretch of Glisson capsule

153

Hepatic vein thrombosis

Budd-Chiari syndrome

154

Vessel invaded by HCC in Budd-Chiari syndrome

Hepatic vein

155

Invasion of hepatic vessels by HCC

Budd-Chiari syndrome

156

Schistosomiasis: Pre- vs postsinusoidal obstruction

Pre

157

Portal htn: Pre vs postsinusoidal obstruction

Post sinusoidal obstruction

158

Most specific tumour marker for hepatocellular CA

AFP-L3

159

Tumor marker for hepatocellular CA that is induced by absence of Vitamin K

PIVKA-2

160

Mucin-producing adenoCA in the LGBP

Cholangiocarcinoma

161

T/F CholangioCA has the propensity for early invasion of vascular channels like hepatocellular CA

T

162

Organisms associated with development of cholangioCA

3C's Cholangiocarcinoma
1) Chlonorchis sinensis (Chinese liver fluke)
2) (Cat) Opisthorchis felineus

163

Tumor found at the bifurcation of the right and left hepatic ducts to form the common hepatic duct

Klatskin tumor

164

Syndromes associated with hepatoblastoma

1) Beckwith-Weidemann syndrome
2) FAP

165

Most common liver tumor of childhood

Hepatoblastoma

166

Child Turcot Pugh classification is for

Classification of severity of liver disease

167

Classifications of hepatocellular CA under Child-Pugh

A-B-C

168

Classifications of hepatocellular CA under Child-Pugh: Earliest stage

A

169

Components under the Child-Pugh classification

1) Bilirubin
2) Albumin
3) PT INR
4) Encephalopathy
5) Ascites

170

Brain waves seen in encephalopathy

Delta waves

171

Substance used to test for the biosynthetic function of the liver in acute liver failure

Vitamin K dependent factors (PT)

172

Substance used to test for the biosynthetic function of the liver in chronic liver failure

Albumin

173

Half-life of albumin

10-14d

174

T/F Fatty liver is reversible

T

175

Induction of fibrosis in the liver occurs with activation of

Hepatic stellate cells

176

Chief worldwide cause of cirrhosis

Alcoholism

177

Gross description of alcoholic cirrhosis

Micronodular surface

178

Alcoholic cirrhosis is aka (2)

1) Blind man's disease
2) Laenec's cirrhosis

179

Inherited metabolic liver diseases

1) Hemochromatosis
2) Wilson's disease
3) a1 anti-trypsin deficiency
4) Cystic fibrosis

180

Reaction in which cephalosporins and metronidazole cause increased acetate production in alcoholic cirrhosis

Disulfiram reaction

181

Ethanol oxidation occurs via ADH to form

Acetaldehyde

182

Acetaldehyde is metabolized to acetate by what enzyme

Acetaldehyde dehydrogenase (ALDH)

183

Central event in the pathogenesis of alcoholic liver cirrhosis

Stellate cell activation

184

Hemolytic anemia seen in patients with alcoholic hepatitis

Zieve's syndrome

185

Most common disease transmitted by blood transfusions

Hepatitis

186

Virus responsible for hepatitis transmission in needle sharing and blood transfusion

Hepatitis C

187

Hepatitis virus associated with hepatitis in concomitant alcohol users

Hepatitis C

188

Hepatitis B vs C: Chronic hepatitis

C

189

T/F Majority of HBV infected patients develop cirrhosis

F

190

Hepatitis virus responsible for vertical transmission

B

191

T/F Most patients with primary biliary cirrhosis are symptomatic

F

192

First symptom of primary biliary cirrhosis

Pruritus

193

AST ALT ratio in primary biliary cirrhosis

2:1

194

Liver biopsy in primary biliary cirrhosis is withheld for this duration to determine residual nonreversible disease

Abstinence maintained for at least 6 months

195

Cytokine implicated in development of primary biliary cirrhosis

TNF

196

Antibodies present in about 90% of patients with primary biliary cirrhosis

Antimitochondrial antibodies (AMA)

197

Etiology of primary biliary cirrhosis

Unknown

198

Treatment of choice for decompensated primary billary cirrhosis

Liver transplantation

199

Treatment for primary biliary cirrhosis that has been shown to improve both biochemical and histologic features of disease

UDCA

200

Treatment for cirrhosis due to chronic hepatitis B

Lamivudine

201

What class of drug is Lamivudine

Reverse transcriptase inhibitor

202

Chronic cholestatic syndrome characterised by diffuse inflammation and fibrosis involving the entire biliary tree resulting in chronic cholestasis

Primary sclerosing cholangitis

203

Cause of primary sclerosing cholangitis

Unknown

204

Imaging technique of choice for evaluation of primary sclerosing cholangitis

MRI with MRCP

205

Antibody present in majority of patients with primary sclerosing cholangitis

p-ANCA

206

Treatment of choice for cirrhosis due to chronic hepatitis C (2)

1) Pegylated interferon
2) Ribavirin

207

Side effects of pegylated interferon and ribavirin for chronic hepatitis C

1) Leukopenia
2) Thrombocytopenia

208

APACHE

ICU mortality

209

Ranson

Predicts severity based on findings on admission and within 48 hours

210

Bisap

Bedside index of severity in acute pancreatitis