2010 Panre Study-Gastroenterology

Front 1

this is the recurrent reflux of gastric contents into the distal esophagus because of mechanical or functional abnormality of lower esophageal sphincter

Back 1

reflux esophagitis

Front 2

reflux causes erosion of the esophagus that leads to this in a minority of pts

Back 2

barrett esophagitis (replacement of normal squamous epithelium with metaplastic columnar epithelium) which can predispose to malignancy

Front 3

symptoms of reflux

Back 3

heartburn worse after eating or lying down, regurgitation or dysphagia; hoarseness, halitosis, cough, hiccups, chest pain

Front 4

when do you do a barium swallow in a pt with reflux

Back 4

dysphagia; it may identify a large hiatal hernia

Front 5

when do an EGD in pt with reflux

Back 5

symptoms are sever or do not respond to medicine

Front 6

when do you do pH monitoring in pt with reflux

Back 6

this is done to confirm and quantify pathology; indicated in pt who do not respond to treatment, recurrence of symptoms after treatment, need surgery

Front 7

treatment of reflux

Back 7

antacids or alginic acid (gaviscon) for mild symptoms, H2 blockers for mild symptoms, PPIs for mod-severe symptoms or evidence of erosive gastritis

Front 8

what meds should be avoided in pts with reflux

Back 8

anticholinergic, beta adrenergic and calcium channel blockers

Front 9

what pt migh have infectious esophagitis

Back 9

immunocompromised persons

Front 10

common causes of infectious esophagitis

Back 10

Fungal (candida, look for oral thrush), Viral (CMV, herpes simplex), rare causes include TB, HIV, EBV

Front 11

main clinical feature in immunocompromised pt with infectious esophagitis is....

Back 11

odynophagia (painful swallowing) or dysphagia (difficult swallowing)

Front 12

most common symptom for esophageal motility disorder

Back 12

dysphagia

Front 13

will neurogenic dysphagia affect swallowing of solids or liquids

Back 13

both

Front 14

this esophageal motility disorder can cause regurgitation of undigested food and liquid into the pharynx several hours after eating

Back 14

zenker's diverticulum

Front 15

slow progression of solid food dysphagia suggests

Back 15

esophageal stenosis, slow progression...webs/rings, rapid progression....malignancy

Front 16

global esophageal motor disorder in which peristalsis is decreased and lower esophageal sphincter tone increased, causing slowly progressive dysphagia with episodic regurgitation and chest pain

Back 16

achalasia

Front 17

what diagnostic study would show you both structural and motor abnormality of the esopagus that may cuase dysphagia

Back 17

barium swallow

Front 18

typical appearance of achalasia on barium swallow

Back 18

"parrot-beaked" appearance`

Front 19

most common type of esophageal neoplasm

Back 19

95% are squamous cell carcinoma

Front 20

linear mucosal tear in esophagus, generally at GE junction, occurs with forceful vomiting or retching causing hematemesis

Back 20

mallory-weiss tear

Front 21

mallory-weiss tear is often associated with this....

Back 21

alcohol use

Front 22

diagnosis and treatment of mallory-weiss tear

Back 22

diagnose by EGD, most resolve without treatment, can inject epinephrin or thermal coagulation may be required

Front 23

this is dilation of the veins of the esophagus, generally at distal end

Back 23

esophageal varices

Front 24

this is the underlying cause of esophageal varices in adults

Back 24

portal hypertension

Front 25

most common causes of portal hypertension

Back 25

cirrhosis either from alcohol abuse or from chronic viral hepatitis

Front 26

diagnosis of esophageal varices

Back 26

pt with cirrhosis presents with hematemesis

Front 27

2 steps of treatment of esophageal varices

Back 27

hemodynamic support and control bleeding, (30% mortality with 1st bleed & 50% within 6 weeks);
endoscopic therapy and pharmocologic vasoconstriction (octreotide) are preferred therapy

Front 28

this is inflammation of the stomach

Back 28

gastritis

Front 29

name an example of an autoimmune disorder that causes type A gastritis (involves the body of the stomach)

Back 29

pernicious anemia

Front 30

this is a Gram-negative, spiral-shaped bacillus which can cause type B gastritis (involves the antrum and body of stomach)

Back 30

Helicobacter Pylori

Front 31

H. Pylori is often associated with these three conditions

Back 31

Peptic ulcer, gastric adenocarcinoma, gastric lymphoma

Front 32

common indicators of gastritis

Back 32

abdominal pain, dyspepsia

Front 33

this is defined as an alteration in gastric motility

Back 33

delayed gastric emptying

Front 34

causes of delayed gastric emptying

Back 34

myopathic diseases of the smooth muscles & neurologic dysfunction

Front 35

clinical features of delayed gastric emptying

Back 35

nausea and feeling of excessive fullness after meals

Front 36

treatment of delayed gastric emptying

Back 36

prokinetic agents (cisapride, metoclopramide)

Front 37

an ulcer of the upper digestive tract

Back 37

Peptic ulcer disease (gastric or duodenal ulcer)

Front 38

most common cause of PUD

Back 38

H. pylori

Front 39

lifetime risk of ulcer disease

Back 39

5-10%

Front 40

clinical features of PUD

Back 40

abdominal pain or discomfort (primary feature, descibed as burning or gnawing, often radiates to back, [duodenal ulcer pain often improves with food, gastric ulcer typically worsens causing associated weight loss]), dyspepsia (belching, bloating, distention, heartburn) or nausea

Front 41

treatment for PUD

Back 41

avoid smoking, alcohol, NSAIDs; antacids, H2 blockers, sucralfate heal duodenal ulcers 4-6 wks, gastric ulcers within 8 wks

Front 42

treatment for PUD + H pylori

Back 42

PPI with clarithrobycin & amoxil; bismuth subsalicylate + tetracycline, metronidazole, & PPI; ranitidine, clarithromycin & amoxil, tetracycline or netronidazole

Front 43

use this prophylactically for pt who has history of ulcer who needs daily NSAID, chronic steroids or anticoagulants

Back 43

misoprostol or PPI

Front 44

gastrin-secreting tumor causing hypergastrinemia which results in refractory PUD

Back 44

zollinger-ellison syndrome (ZES)

Front 45

labs in pt with zollinger-ellison syndrome

Back 45

fasting gastrin level >150 indicates hypergastrinemia; need secretin test to confirm ZES, give secretin 2 U/kg IV, gastrin levels go up by more than 200 pg/mL in ZES

Front 46

treatment of ZES

Back 46

PPIs to control gastrin secretion; surgical resection of gastrinoma

Front 47

most common cause of cancer worldwide but less common in US

Back 47

gastric adenocarcinoma

Front 48

pt that you need to consider gastric adenocarcinoma in

Back 48

men 2x more likely than women, almost never occurs under age of 40

Front 49

there is a strong association of gastric adenocarcinoma and.....

Back 49

H pylori

Front 50

signs & symptoms of gastric adenocarcinoma

Back 50

dyspepsia, weight loss, anemia, occult GI bleeding in pt >40 yo. progressive dysphagia if ceoplasm impinging on esophagus, postprandial vomiting if near pylorus

Front 51

signs of metastatic spread of gastric adenocarcinoma include virchow's node and sister mary joseph nodule. what are they....

Back 51

Virchow's node-left supraclavicular lymphadenopathy, Sister Mary Joseph nodule-an umbilical nodule

Front 52

this is the most common extranodal site for non-Hodgkin's lympoma

Back 52

stomach

Front 53

increased frequency or volume of stool (3 or more liquid or semisolid stools daily for at least 2-3 consecutive days)

Back 53

diarrhea

Front 54

secretory diarrhea (large volume without inflammation) indicates

Back 54

pancreatic insufficiency, ingestion of preformed bacterial toxins, laxative use

Front 55

symptoms of inflammatory diarrhea

Back 55

bloody diarrhea & fever

Front 56

causes of inflammatory diarrhea

Back 56

invasive organisms or inflammatory bowel disease

Front 57

antibiotic associated diarrhea is almost always caused by...

Back 57

clostridium difficile colitis (C. diff), which n most sever cases causes classic pseudomembranous colitis

Front 58

lab findings if inflammatory process is cause of diarrhea

Back 58

WBCs in stool

Front 59

treatment of diarrhea

Back 59

supportive is sufficient for most pts w/ viral or bacterial; antibiotics for pts w/ severe diarrhea & systemic symptoms

Front 60

this can be the cause of diarrhea in a patient that has eaten poultry

Back 60

salmonella, campylobacter if undercooked poultry

Front 61

this can be the cause of diarrhea in a patient that has eaten undercooked ground beef

Back 61

enterohemorrhagic (E. coli)

Front 62

normal bowel function is what

Back 62

3 stools/day to 3 stools/week

Front 63

define constipation

Back 63

decrease in stool volume and increase in stool firmness accompanied by straining

Front 64

in what pts with constipation should you evaluate for colon cancer

Back 64

pts >50yo with new onset constipation

Front 65

nonpharmacological treatment for constipation

Back 65

increase in fiber (to 10-20 g daily) & fluid intake (up to 1.5-2 L/day), increased exercise

Front 66

abdominal pain, distention, vomiting of partially digested food, & obstipation suggests

Back 66

small bowel obstruction

Front 67

treatment of bowel obstruction

Back 67

surgical, large bowel being more urgent than small bowel

Front 68

Examples of malabsorption that involves a single nutrient

Back 68

pernicious anemai (B12), lactase deficiency (lactose)

Front 69

causes of malabsorption

Back 69

problems in digestion, absorption, or impaired blood and lymph flow

Front 70

complaints in pt with malabsorption

Back 70

diarrhea is primary complaint, bloating and abdominal discomfort, weight loss, edema, steatorrhea (excessive fat in feces)

Front 71

use this test to distinguish maldigestion (pancreatic insufficiency, bile salt deficiency) from malabsorption

Back 71

D-xylose test

Front 72

if this test is normal in a pt with malabsorption symptoms u should consider pancreatic insufficiency and abnormal bile salt metabolism

Back 72

72 hour fecal fat test

Front 73

treatment of celiac disease

Back 73

gluten-free diet

Front 74

treatment for pancreatic insufficency

Back 74

pancreatic enzyme replacement

Front 75

another name for regional enteritis

Back 75

Crohn's disease

Front 76

this is an inflammatory bowel disease for which there is some genetic predisposition, cause is unknown

Back 76

Crohn's disease

Front 77

organs involved in Crohn's disease

Back 77

small & large intestine, mouth, esophagus, & stomach; most commonly terminal ileum & right colon; rectum is frequently spared

Front 78

complications of Crohn's disease

Back 78

fistulas, abscesses, aphthous ulcers, renal stones, predisposition to colonic cancer

Front 79

clinical features of Crohn's disease

Back 79

abdominal cramps & diarrhea in pt < 40 r most common, low grade fever, polyarthralgia, anemia, fatigue, blood in stool

Front 80

findings on barium enema or CT in Crohn's disease

Back 80

cobblestone-pattern filling defects with segmental areas of involvement (skip lesions)

Front 81

In pt with Crohn's disease, colonoscopy is valuable in diagnosis, but contrast studies and endoscopic procedures should be avoided with fulminant disease because of.....

Back 81

possibility of inducing toxic megacolon

Front 82

what will biopsy show in pt with Crohn's disease

Back 82

involvement of entire bowel wall

Front 83

first step in medical treatment for pt with crohn's

Back 83

aminosalicylates (sulfasalazine, mesalamine); metronidazole or cipro is added in perianal disease, fissures, or fistulae

Front 84

treatment for Crohn's if aminosalicylates are not effective

Back 84

corticosteroids

Front 85

Crohn's disease treatment for refractory or frequent flare-ups requiring corticosteroids

Back 85

immunomodulatory agents (6-mercaptopurine or azathioprine); infliximab is also approved but very $$$$$

Front 86

This disease generally starts distally, at the rectum and pregresses proximally, it is continuous, skip areas are not seen, onset is usually gradual

Back 86

ulcerative colitis

Front 87

clinical features of this include tenesmus & bloody, pus-filled diarrhea, (less commonly--- LLQ pain, weight loss, malaise, fever

Back 87

ulcerative colitis

Front 88

is toxic megacolon and malignancy more likely in ulcerative colitis or Crohn's disease

Back 88

ulcerative colitis

Front 89

lab findings in ulcerative colitis

Back 89

anemia, elevated sed rate, low albumin

Front 90

best method to diagnose ulcerative colitis

Back 90

sigmoidoscopy or colonoscopy (avoid in acute disease b/c risks of perforation & toxic megacolon

Front 91

treatment of ulcerative colitis

Back 91

topical or oral aminosalicylates & corticosteroids; surgery can be curative, segmental resection if possible, total proctocolectomy is most common surgical cure

Front 92

a functional disorder without pathology, thought to be a combination of altered motility, hypersensitivity to intestinal distention and psychological distress

Back 92

irritable bowel syndrome (IBS)

Front 93

this is the most common cause of chronic or recurrent abdominal pain in the US

Back 93

IBS

Front 94

when do symptoms of IBS typically begin

Back 94

early to mid adulthood

Front 95

differential diagnosis in pt with IBS

Back 95

lactose intolerance, cholecystitis, chronic pancreatitis, intestinal obstruction, chronic peritonitis, carcinoma of pancreas and stomach

Front 96

physical exam findings in IBS

Back 96

gernerally normal but may be tender, palpable sigmoid colon and hyperresonance on percussion over the abdomen

Front 97

factors that affect abdominal pain in IBS

Back 97

worsened with food intake, relieved with defacation, pain may be axxociated with bowel distention from acumulation of gas and associated spasm, postprandial urgency is common

Front 98

what urinary symptoms may be found in IBS

Back 98

urinary urgency & frequency in women

Front 99

labs in IBS

Back 99

usually normal, test stool for blood, bacteria, parasites, lactose tolerance; barium enema, u/s or CT to r/o other pathology; endoscope for persistent symptoms, weight loss, anorexia, bleeding, history of other GI pathology

Front 100

treatment of IBS

Back 100

reassurance, high fiber diet, bulking agents (psyllium hydrophilic mucilloid), antispasmodics, antidiarrheals, prokinetics, antidepressants if indicated by pt's symptoms

Front 101

invagination of proximal segment of bowel into portion just distal to it

Back 101

intussusception

Front 102

who and when might you see intussusception

Back 102

children (95% of time) following a viral illness, in adults, almost always caused by neoplasm

Front 103

exam findings in intussusception

Back 103

children-severe, colicky pain, mucus/blood in stool if passed,
sausage-like mass may be felt on abd. exam; adults-crampy abdominal pain, bloody stool and mass are rare

Front 104

radiology & treatment for intussusception

Back 104

children-barium/air enema is diagnostic & therapeutic, if not then surgery; adults-do not do barium enema, CT scan but most cases not found till surgery, treatment is surgery

Front 105

large outpouchings of diverticula in the colon

Back 105

diverticulosis

Front 106

this is inflammation of diverticula caused by obstructing matter

Back 106

diverticulitis

Front 107

how can u prevent diverticulitis in a pt who has diverticulosis

Back 107

high-fiber diet & avoiding obstructing foods

Front 108

sudden onset of abdominal pain, usually left lower quadrant or suprapubic region, with or without fever; altered bowel movement, nausea & vomiting are common

Back 108

diverticulitis

Front 109

generally presents with large volume sudden-onset hematochezia, resolves spontaneously, continuous or recurrent bleeding are indications for surgery

Back 109

diverticular bleeding

Front 110

treatment for diverticulitis

Back 110

low residue diet, broad spectrum antibiotics, bowel rest, analgesics, NG tube for ileus, surgery if peritonitis, large abscess, fistula or obstruction

Front 111

causes of acute mesenteric ischemia

Back 111

arterial embolus, arterial thrombosis, venous thrombosis

Front 112

this condition presents with abdominal angina, with pain occu occurring 10-30 minutes after eating that is relieved somewhat by squatting or lying down

Back 112

chronic mesenteric angina

Front 113

presentation of acute mesenteric angina

Back 113

sudden onset severe abdominal pain out of proportion to exam

Front 114

radiology for mesenteric ischemia

Back 114

plain-film or CT to rule out other cuases, CT can help delineate extent of ischemia, angiography may be helpful

Front 115

this is extreme dilatation & immobility of colon & represents a true emergency

Back 115

toxic megacolon

Front 116

this is a congenital aganglionosis of colon, leading to functional obstruction in the newborn

Back 116

Hirschsprung's disease

Front 117

In adults, toxic megacolon is a complication of one of these diseases.....

Back 117

ulcerative colitis, Crohn's colitis, pseudomembranous colitis, specific infectious causes (amebiasis, shigella, campylobacter, C-diff)

Front 118

clinical findings in toxic megacolon

Back 118

fever, prostration, severe cramps abdominal distention, rigid abdomen, localized diffuse or rebound abdominal tenderness

Front 119

x-ray findings in toxic megacolon

Back 119

colonic dilatation

Front 120

treatment of toxic megacolon

Back 120

decompression of colon, colostomy or complete colon resection may be required

Front 121

this is a genetic predisposition to multiple colonic polyps & a high risk of colonic cancer

Back 121

familial polyposis syndrome

Front 122

3rd leading sause of cancer death in the US

Back 122

colorectal cancer

Front 123

abdominal pain, occult bleeding, intestinal obstruction, change in bowel habits (change in stool shape or size)

Back 123

colorectal cancer

Front 124

what role does CEA levels play in diagnosing colorectal cancer

Back 124

none, may be used to monitor but not detect it

Front 125

why would you give radiation to pt with colorectal cancer

Back 125

reduce tumor size preoperatively

Front 126

when would you give chemo to pt with colorectal cancer

Back 126

with any extension through the serosa or with lymphatic spread

Front 127

painful swelling at anus & painful defecation, localized tenderness, erythema, swelling, fluctuance (indication of the presence of pus in a bacterial infection), fever is uncommon

Back 127

perirectal & perianal abscesses

Front 128

treatment for anorectal abscess

Back 128

surgical drainage followed by warm-water clensing, analgesics, stool softeners, high-fiber diet; do not explore tract on exam as this may open new tracts

Front 129

this is linear lesions in rectal wall, most commonly found on posterior midline

Back 129

anal fissures

Front 130

severe tearing pain on defecation, hematochezia, bright red blood noted on stool or tissure paper

Back 130

anal fissure

Front 131

this is a vaice of the hemorrhoidal plexus

Back 131

hemorrhoids

Front 132

this hemorrhoid is confined to the anal canal and may bleed with defecation

Back 132

stage I internal hemorrhoids

Front 133

this hemorrhoid protrudes from the anal opening but reduces spontaneously, bleeding & mucoid discharge may occur

Back 133

Stage II internal hemorrhoids

Front 134

this hemorrhoid requires manual reduction after bowel movements, pts may develop pain and discomfort

Back 134

Stage III internal hemorrhoids

Front 135

this hemorrhoid is chronically protruding and risk strangulation

Back 135

Stage IV internal hemorrhoids

Front 136

treatment for stage I & II hemorrhoids

Back 136

high fiber diet, increase fluids, bulk laxatives, high stage hemorrhoids treated with suppositories

Front 137

treatment for stage IV hemorrhoids & hemorrhoids unresponsive to conservative treatment

Back 137

surgical treatment (infection, rubber band ligation, sclerotherapy

Front 138

this is an abscess in the sacrococcygeal cleft associated with subsequent sinus tract development

Back 138

pilonidal cyst

Front 139

typical pts you may see a pilonidal cyst in

Back 139

hairy, obese individual, almost always under the age of 40

Front 140

treatment of pilonidal cyst

Back 140

surgery

Front 141

complications of fecal impaction

Back 141

urinary tract obstruction, UTI, spontaneous perforation of the colon

Front 142

what is the cause of appendicitis

Back 142

obstruction of the appenix, by fecalith or other cause, leads to inflammation & infection

Front 143

typical age of appendicitis

Back 143

10-30

Front 144

complications of appendicitis

Back 144

perforation & peritonitis occur 20% of time, causing high fever, generalized abdominal pain, increased WBCs

Front 145

clinical features of appendicitis

Back 145

intermittent periumbilical or epigastric pain, followed by RLQ pain (McBurney's point), worse with movement, rebound tenderness, nausea, anorexia, low grade fever, psoas and obturator sign

Front 146

what is psoas sign

Back 146

pt is supine and attempts to raise the leg against resistance

Front 147

what is obturator sign

Back 147

pt is supine and attempts to flex and internally rotate the right hip with knee bent

Front 148

causes of acute pancreatitis

Back 148

alcohol (most common), cholelithiasis, hyperlipidemia, trauma, drugs, hypercalcemia, penetrating PUD

Front 149

medications that you might suspect to be the cause of pancreatitis

Back 149

antiretoviral medications used to treat HIV

Front 150

clinical features of acute pancreatitis

Back 150

epigastric pain radiating into back, typically improves when pt leans forward or lies in fetal position

Front 151

symptoms other than pain you may see with acute pancreatitis

Back 151

nausea, vomiting, fever, leukocytosis, sterile peritonitis

Front 152

lab findings in acute pancreatitis

Back 152

elevations in wbc, amylase, lipase, liver enzymes, bilirubin, glucose, pt may also develop hypocalcemia

Front 153

this lab is more sensitive and specific

Back 153

lipase-but only with elevations of threefold or greater

Front 154

treatment of acute pancreatitis

Back 154

NPO, parenteral hyperalimentation, meperidine for pain, consider antibiotics

Front 155

complications of acute pancreatitis

Back 155

pancreatic pseudocys, renal failure, pleural effusion, hypocalcemia, pancreatic abscess

Front 156

most common cause of chronic pancreatitis

Back 156

alcohol abuse (90%), other causes: cholelithiasis, PUD, hyperparathyroidism, hyperlipidemia

Front 157

classic triad in chronic pancreatitis

Back 157

DM, pancreatic calcification, steatorrhea

Front 158

treatment for chronic pancreatitis

Back 158

low-fat diet, surgical removal of part of pancreas can control pain, treat underlying cause i.e. alcohol

Front 159

5th leading cause of cancer death n U.S.

Back 159

pancreatic

Front 160

signs & symptoms of pancreatic cancer

Back 160

jaundice, palpable gallbladder (Courvier's sign)

Front 161

most common cause of acute hepatitis

Back 161

viral

Front 162

2 types of hepatitis transmitted by fecal-oral contamination

Back 162

A & E

Front 163

How r hepatitis B, C & D transmitted

Back 163

parenterally or by mucous membrane contact

Front 164

fatigue, malaise, anorexia, nausea, tea-colored urine, vague abdominal discomfort suggests

Back 164

hepatitis

Front 165

this hepatitis is only seen in conjunction with hep. B

Back 165

D

Front 166

these two types of hepatits are frequent co-existent with HIV

Back 166

B & C

Front 167

elevation of aminotransferase indicate

Back 167

hepatocellular damage; this is seen in all types of acute hepatitis

Front 168

HAV IgG (hepatitis A virus IgG) indicates

Back 168

resolved hepatitis A

Front 169

causes of toxic hepatitis

Back 169

alcohol, tylenol, isoniazid phenytoin

Front 170

irreversible fibrosis & nodular regeneration throughout liver

Back 170

cirrhosis

Front 171

treatment of cirrhosis

Back 171

no alcohol, salt restriction, spironolactone 100 mg daily if diuretic needed; liver transplant in selected pts

Front 172

2 types of primary cancer that commonly metastasize to liver

Back 172

lung, breast

Front 173

in hepatic carcinoma this lab test will be elevated

Back 173

alpha-fetoprotein

Front 174

explain pyloric stenosis

Back 174

projectile vomiting, usually 4-6 weeks into life, palpable "olive" mass deep in epigastrium on exam, "sting sign" on the pyloric lumen on barium swallow, treat with surgery

Front 175

what is hirschprung's disease

Back 175

congenital megacolon