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PANRE > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Boerhaave’s Syndrome

A

Esophageal rupture/pert due to severe retching/vomiting

Hematemesis with SEVERE retrosternal “tearing” pain, SQ emphysema/crepitation

CXR= mediastinal widening
Confirmed by CT chest
Emergent surgery

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2
Q

Achalasia

A

Ineffective parastalsis or swallow-induced relaxation of LES

Regurgitation of u digested food

Esophagram with “birds beak” distal esophagus
Confirmed by esophageal manometer-measures peristalsis and strength of LES

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3
Q

Esophageal Varices

A

Dilated veins in lower esophagus
H/o portal HTN/cirrhosis

1/3 will bleed-brisk with hematemesis, melena and hematochezia

Emergent endoscopy
Long term expires= BB, no ETOH

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4
Q

Zenker’s Diverticulum

A

False outpouching
Dysphasia, choking, cough, aspiration, regurgitation of undigested food

Complications-aspiration pneumo/bronchiectasis

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5
Q

Esophageal Web

A

May be result of iron def anemia

Plummer Vinson Syndrome triad= dysphasia, webs, IDA

Treat IDA
EGD/dilation

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6
Q

Esophageal CA

A

Squamous-proximal esophagus
Smokers, ETOH

Adenocarcinoma-distal esophagus
Barrett’s

Dysphasia for solids only
EGD/biopsy

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7
Q

Barrett’s Esophagus

A

Squamous cells replaced with abnormal glandular-type epithelium= met plastic->dysphasia->anenocarcinoma

Orange/salmon colored patch on EGD
Treat with radio frequency endoscopic ablation and long term PPI

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8
Q

H pylori

A

Urea Breath test
Rx: amox+ Clarith+ PPI
Retest 1 month after completion (no PPI or bismuth until retested)

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9
Q

Ulcers

A

Gastric: pain after eating
Duodenal: relieved with food

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10
Q

Zollinger-Ellison Syndrome

A

Gastrinoma of pancreas or duodenum

Consider in recurrent PUD, PUD with hypercalcemia, severe and pain/diarrhea, elevated serum gastrin level

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11
Q

Gastric Carcinoma

A

Adenocarcinoma
H pylori is strong risk factor
Vague dyspepsia with weight loss

EGD all dyspepsia > 55 if new, persistent or fails empiric treatment

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12
Q

Bilirubin

A

Unconjugated/Indirect= pre-liver
Stool and urine normal, mild jaundice
Causes: hemolysis, Gilbert’s

Conjugated/Direct-jaundice, dark urine, light stools
Causes: biliary obstruction, hepatic ellipse dysfunction, inherited

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13
Q

Primary Biliary Cirrhosis

A

Autoimmune

Fatigue, jaundice, pruritis, mild hepatomegaly

Elevated Alk Phos
+AMA
Liver bx= gold standard to confirm
Treat with bile acid drugs, transplant

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14
Q

Autoimmune Hepatitis

A 
Fatigue, anorexia, arthralgias, jaundice
Younger women (30-50)
Elevated transaminases
\+ANA
\+ ASMA
Treat with prednisone/immunomodulators
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15
Q

Primary Sclerosing Cholangitis

A 
Mostly young men (20-40)
Often associated with IBD/ulcerative colitis
ERCP-thick/narrowed bile duct
Elevated total bili, Alk Phos
Leads to end stage liver disease
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16
Q

Cholangiocarcinoma

A

Non-tender palpable GB with hx of weight loss

Klatskin tumor- hilar cholangiocarcinoma. Junction of right and left hepatic ducts.

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17
Q

Pancreatitis

A

Etiology: gallstones, ETOH
Severe epigastric pain radiating to back
Dx: CT
Ransom’s criteria= necrotizing pancreatitis (elevated age, WBC, glucose, LDH, AST. Low Ca++)

Rx-IV hydration, NPO, pain meds, pancreatic enzyme replacement.

CA 19-9=helpful tumor marker for CA

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18
Q

Hemochromatosis

A

Fe overload
Sxs: arthralgias, hepatomegaly, gray skin, cardiomegaly, DM, ED

Hallmark=increased %transferrin sat
Rx=weekly phlebotomy

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19
Q

Wilson’s Disease

A

Copper overload
Kay-Fleischer ring on eye exam
Rx= Penicillamine (copper chelation agent)

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20
Q

Hepatitis A

A

Fecal-oral transmission
Mild disease
No chronic carrier
No Rx necessary, avoid ETOH

21
Q

Hepatitis B

A

Chronic carrier 5-10%

Major risk factor for liver CA if carrier

22
Q

Hepatitis C

A 
Leading cause of chronic liver failure
Most common indication for transplant
Most asymptomatic
Screen with EIA, RIBA to confirm
HCV RNA establish chronicity and follow RX

Test Genotype (most type 1)

Rx: interferon+Ribaviron.
Not in psych pts, autoimmune disease, CA patients
Contraindication=Ongoing ETOH/drugs

23
Q

Alcoholic Hepatitis

A 
AST > ALT (>2x)
Prolonged PT/low Albumin=poor prognosis
Vit deficiency (folate/ B's)
24
Q

Nonalcoholic fatty liver:NASH

A

Mildly elevated AST/ALT and alk phos
Dx: US
RX: weight loss/exercise

25
Q

Cirrhosis

A

Complications-portal htn, esophageal varices, ascites, peritonitis, encephalopathy (Wernicke’s)

26
Q

Hepatocellular Carcinoma

A

Tumor marker= AFPo

27
Q

Crohn’s

A

75% terminal ileum/cecum, 25% colon
Typically spares rectum
“Skip” lesions
Full thickness ulcer, anywhere

Sxs: Colicky RLQ pain, diarrhea, low grade fever, weight loss

Complications: SBO, fistula

Gold standard= colonoscopy
Findings: string sign, skip lesions, cobblestoning

100x increase risk small bowel CA

28
Q

Mesenteric Ischemia

A

Abd pain sudden/severe/out of proportion, post-prandial

H/o vascular disease
CT angiography

29
Q

Celiac Sprue

A 
Loss of absorptive surface results in malabsorption
Abnormal response to gluten
No villi at duodenum on EGD
Sx: weight loss, diarrhea, FTT in kids
Gold standard= biopsy (abnormal villi)

Can’t eat: BROW
Can eat: CRAP

30
Q

Dermatologic clue to Sprue

A

Dermatitis herpetiformis

Puritic papulovesicles extensor surfaces of trunk and neck

Happens in

31
Q

Ulcerative Colitis

A 
Superficial ulcerations, friable mucosa
Crampy pain (often LLQ), bloody diarrhea

Begins distal rectum and spreads proximally
Continuous lesion, rectum always involved

Complications: toxic megacolon, perforation, cancer
Need yearly colonoscopy after 7-8yrs

32
Q

Hepatitis A

A

Fecal-oral transmission
Mild disease
No chronic carrier
No Rx necessary, avoid ETOH

33
Q

Hepatitis B

A

Chronic carrier 5-10%

Major risk factor for liver CA if carrier

34
Q

Hepatitis C

A 
Leading cause of chronic liver failure
Most common indication for transplant
Most asymptomatic
Screen with EIA, RIBA to confirm
HCV RNA establish chronicity and follow RX

Test Genotype (most type 1)

Rx: interferon+Ribaviron.
Not in psych pts, autoimmune disease, CA patients
Contraindication=Ongoing ETOH/drugs

35
Q

Alcoholic Hepatitis

A 
AST > ALT (>2x)
Prolonged PT/low Albumin=poor prognosis
Vit deficiency (folate/ B's)
36
Q

Nonalcoholic fatty liver:NASH

A

Mildly elevated AST/ALT and alk phos
Dx: US
RX: weight loss/exercise

37
Q

Cirrhosis

A

Complications-portal htn, esophageal varices, ascites, peritonitis, encephalopathy (Wernicke’s)

38
Q

Hepatocellular Carcinoma

A

Tumor marker= AFPo

39
Q

Crohn’s

A

75% terminal ileum/cecum, 25% colon
Typically spares rectum
“Skip” lesions
Full thickness ulcer, anywhere

Sxs: Colicky RLQ pain, diarrhea, low grade fever, weight loss

Complications: SBO, fistula

Gold standard= colonoscopy
Findings: string sign, skip lesions, cobblestoning

100x increase risk small bowel CA

40
Q

Mesenteric Ischemia

A

Abd pain sudden/severe/out of proportion, post-prandial

H/o vascular disease
CT angiography

41
Q

Celiac Sprue

A 
Loss of absorptive surface results in malabsorption
Abnormal response to gluten
No villi at duodenum on EGD
Sx: weight loss, diarrhea, FTT in kids
Gold standard= biopsy (abnormal villi)

Can’t eat: BROW
Can eat: CRAP

42
Q

Dermatologic clue to Sprue

A

Dermatitis herpetiformis

Puritic papulovesicles extensor surfaces of trunk and neck

Happens in

43
Q

Ulcerative Colitis

A 
Superficial ulcerations, friable mucosa
Crampy pain (often LLQ), bloody diarrhea

Begins distal rectum and spreads proximally
Continuous lesion, rectum always involved

Complications: toxic megacolon, perforation, cancer
Need yearly colonoscopy after 7-8yrs

44
Q

Diverticular hemorrhage

A

Most common Lower GI bleed (50%)
Most self limiting
Acute, painless, large volume maroon/mahogany or bright red bloody stools

45
Q

Diverticulitis

A 
LLQ pain and mass, fever, leukocytosis
Plain films to look for free air/obstruct
CT if no improvement 2-4 days
**No BE or scope acutely
Surgical resection if 3 attacks
46
Q

Nutritional Deficiencies:

Vit A, C, D, K
Thiamine
Niacin
Pyridoxine (B6)

A 
A-night blindness, poor wound healing
C-scurvy
D-osteomalacia
K-blood dyscrasias
Thiamin (B1)-ETOH/Beri-beri
Niacin (B3)-Pellagra (3 D's)-diarrhea, dementia, dermatitis
Pyridoxine (B6)-INH/ocp's
47
Q

Lower GI bleed

A

Below Ligament of Treitz

Most common cause>50= diverticulosis

48
Q

Mallory-Weiss Tear

A 
Mucosal tear of GE junction from vomiting
Self-limited (usually)
Painless hematemesis
Dx-EGD
Rx-supportive
49
Q

Eosinophilic Esophagitis

A

Eosinophil-predominant inflammation
Concentric esophageal rings
PPI, topical glucocorticoids (swallowed fluticasone)
?food allergy eval

PANRE (4 decks)

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