0405111000 - Gi E2 - Dz Of Si Li (Riggs)

Front 1

What is clinically significant about Meckel's Diverticulum?

Back 1

1. most frequent congenital anomaly of the digestive tract
2. < 1/2 contain gastric mucosa but ONLY these ulcerate and bleed
3. meckel's is the culprit for 50% of all GI bleeds in children

Front 2

How is technetium helpful in dx of Meckel's diverticulum?

Back 2

technetium is taken up by gastric mucosa which is abnormal and present in 50% of meckel's. the gastric mucosa containing meckel's are they only ones that ulcerate and bleed. technetium scan is the dx tool of choice.

Front 3

How is diverticulitis treated?

Back 3

antibiotics that cover both aerobic and gram negative anaerobic like metronidazole + cipro or TMP/SMX

don't give metro to pregnant or alcoholic. don't give cipro to children.

Front 4

What is a fundamental exam for working up large bowel dz?

Back 4

digital rectal. thanks, dr. seaman. 50% of all rectal CAs can be felt with a DRE.

Front 5

When is angiography used in GI dz?

Back 5

1. chronic/acute mesenteric ischemia
2. severe lower GI bleed (rarely used for upper GI bleed)
3. TIPS for variceal bleeding
4. used therapeutically for embolism or vasopressin

Front 6

Angiography is most successful when the rate of blood loss is what?

Back 6

0.5 or greater

Front 7

What is diverticulosis?

Back 7

dz of motility that is very common clinically where diverticula occur where the muscle layer is weak. they occur most commonly in the sigmoid colon because of the increased pressure. makes sense, then that acquired is more common than congenital.

Front 8

What is an important differential to include with diverticulosis?

Back 8

CA. don't assume that a patient's symptoms are diverticular in origin until neoplasm has been ruled out.

Front 9

What are the 4 types, indicating the most common, of diverticular dz?

board, but not exam here

Back 9

1. asymptomatic - most common
2. painful diverticulosis
3. diverticular bleeding
4. diverticulitis

Front 10

What diagnostic tool should be avoided with diverticulosis?

Back 10

colonoscopy requires expansion of the colon with gas insertion. because the tissue could be weak. this could cause a rupture. avoid colonoscopy

Front 11

What should one suspect with severe attacks with acute peritoneal signs and diverticulitis?

Back 11

suspect abscesses or perforations.

Front 12

What is the most useful radiological study to dx diverticulitis?

Back 12

CT scan

Front 13

What is diverticulitis due to?

Back 13

microperforations

Front 14

How does diverticulitis present clinically?

Back 14

LLQ pain, fever, leukocytosis, can have LLQ rebound tenderness, sigmoid mass on imaging

Front 15

What is the most common cause of bleeding of the elderly pt > 60?

Back 15

MC = diverticular hemorrhage (will be more profuse "full-on faucet" bleeding, painless)
2nd MC = angiodysplasia (more occult "drippy faucet" bleeding)

Front 16

What sidedness do diverticular hemorrhage bleeds usually take on?

Back 16

R side, even though clinically presentation of pain and tenderness is more commonly L sided.

Front 17

How is diverticular hemorrhage dx'ed?

Back 17

colonoscopy or technetium tagged RBC scan. angiography if bleeding is severe or continuous.

Front 18

* What is Ogilvie's syndrome?

Back 18

it's an acute, nontoxic "mega colon" presentation of pseudoobstruction. it shows up as massive dilation of the colon on AXR. there is no mechanical obstruction present.

Front 19

* When is cecostomy indicated in Ogilvie's syndrome?

Back 19

cecostomy is indicated when the diameter of the colon exceeds 8 cm to avoid ischemic necrosis and perforation

Front 20

What is the significance of IBS?

Back 20

most common GI dz in clinical practice, more common in females usually < 45 yo

Front 21

Are there nocturnal or organic symptoms with IBS?

Back 21

yeah, no. i don't think so. definitely not.

Front 22

What concurrent dzs will present with a complicate IBS?

Back 22

1. 2-4% have concurrent celiac sprue
2. 33% of lactose intolerance will not resolve with lactose restriction because they have concurrent IBS

Front 23

How is IBS treated?

Back 23

Antispasmodic (anticholinergics), but a lot of pts will respond well to placebo.

Front 24

What is the only treatment for arterial insufficiency?

Back 24

surgical bypass, NOT the same as mesenteric venous thrombosis

Front 25

What blood condition is mesenteric venous thrombosis related to? This should be obvious.

Back 25

hypercoagulable states, so treated with thrombolytics and long-term anticoagulants

Front 26

* What is the most common cause of ischemic colitis?

Back 26

usually NOT SPECIFIC CAUSE. can be related to low flow/ HF/hypercoagulability, and usually nonocclusive

Front 27

* When is ischemic colitis dx'ed with colonoscopy?

Back 27

ONLY if there are no signs of peritonitis.

Front 28

* What is Heyde syndrome?

Back 28

GI AVM and AS

Front 29

* What is Osler-Rendu-Weber syndrome?

Back 29

also known as Hereditary hemorrhagic telangiectasia (HHT), it is a genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs. It has a characteristic presentation on the lower lip. see the pic.

Front 30

Where do SI carcinoid tumors found?

Back 30

argentaffin cells of the crypts of Leiberkuhn in the midgut.

Front 31

If an inflammatory bowel dz is in the ileum, then is it Crohn's or ulcerative colitis?

Back 31

Crohn's, man! U.C. doesn't occur anywhere but in the colon. check out the pic and be able to tell the difference.

Front 32

* What are the significant labs to differentiate Crohn's from UC?

Back 32

+ ASCA / - pANCA = Crohn's
- ASCA / + pANCA = UC

Front 33

Why should you not tell a pt that they have Crohn's dz without biopsy?

Back 33

Crohn's is a preexisting condition. Don't ever tell a pt

Front 34

* What is the significance of sulfasalazine and IBD?

Back 34

Sulfasalazine causes reversible infertility in men as a result of abnormal spermatogenesis and decreased motility.

Front 35

What is celiac dz also known as?

Back 35

non-tropical sprue

Front 36

What is the HLA associated with celiac dz?

Back 36

HLA-DQ2 is present in 95% of patients

Front 37

What skin conditions are related to Celiac Dz?

Back 37

psoriasis and dermititis herpetiformis

for boards

Front 38

* What is the test of choice for celiac dz?

Back 38

tTg IgA

Front 39

What is oculomasticatory myorrhythmia?

Back 39

pendular vergence oscillations of the eyes and synchronous contractions of the masticatory but not palatal muscles that is oathognomonic for whipple's dz

Front 40

What histologically is significant with Whipple Dz?

Back 40

PAS positive, foamy macrophages

Front 41

What is a differential for hemorrhage and should not be excluded until dx is positive for hemorrhoids?

Back 41

colorectal CA

Front 42

What are the clinical manifestations of Whipple's?

Back 42

4 cardinal clinical manifestations

1. MC sx = arthralgia for YEARS before dx
2. weight loss
3. diarrhea
4. abdominal pain

Front 43

How does relapse of Whipple's often manifest?

Back 43

CNS symptoms

Front 44

What factors influence bacterial overgrowth in the gut?

Back 44

1. structural abnormalities
2. non-normal gut motility
3. excessive bacterial load
4. deficient host defense

Front 45

What anatomical structures compose internal and external hemorrhoids?

Back 45

internal - venous swelling from gnlarged internal hemorrhoidal plexus and /\ supporting tissue mass

external - external hemorrhoidal plexus enlargement or thromboses, resulting in bluish mass

Front 46

What is a common symptom of internal hemorrhoids?

Back 46

painless bright red bleeding on the toilet paper and the feeling of vague anal discomfort