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106 Cards in this Set
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- 3rd side (hint)
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Criteria for predicting mortality associated with acute pancreatitis |
Ranson's criteria
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Ranson's criteria risk percentage for mortality
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20% with 3-4 signs
40% with 5-6 signs 100% with >7 signs |
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Courvoisier's sign
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Palpable, nontender gallbladder, a sign of pancreatitis (porcelin gallbladder)
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3 most common pathogens of infectious esophagitis
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Candida albicans, CMV, and HSV
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Oropharyngeal dysphagia: does it involve liquids or solids more?
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Liquids
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difficulty initiating a swallow
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Obstructive esophageal dysphagia: does it involve liquids or solids more?
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Solids
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Esophageal motility disorders (name some)
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Achalasia, scleroderma, and esophageal spasm
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Barium swallow shows a corkscrew-shaped esophagus
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Diffuse esophageal spasm
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Impaired relaxation of the lower esophageal sphincter, loss of peristalsis in the lower 2/3 of the esophagus
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Achalasia
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Barium swallow shows esophageal dilation with a "bird's beak" tapering of the distal esophagus
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Achalasia
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Treatment for achalasia
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Nitrates, CCBs, or endoscopic injection of botox into the LES for short-term relief. Pneumatic dilation or surgical myotomy for long-term relief
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2 most common types of esophageal cancer
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Squamous cell carcinoma and adenocarcinoma
(barrets assoc with adeno in distal 1/3) |
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Risk factors of esophageal cancer
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Alcohol use, male gender, smoking, and age >50
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Symptomatic reflux of gastric contents into the esophagus, most commonly as a result of transient lower esophageal sphincter (LES) relaxation
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GERD
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BARRett's esophagus
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Becomes
Adenocarcinoma, Results from Reflux |
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The gastroesophageal junction and a portion of the stomach displaced above the diaphragm
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Sliding hiatal hernia
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Treatment for gastritis
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Stop offending agents. Antacids, sucralfate, H2 blockers, and/or PPIs.
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H. pylori treatment
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Triple therapy with amoxicillin, clarithromycin, and omeprazole/lansopraxole
quad:=bismuth+ PPI+ tetracyline+ metronidzole |
triple therapy
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Abdominal pain, early satiety, and weight loss
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Gastric cancer. Usually presents with an advanced case, and has a 5-year survival of <10%
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Risk factors for gastric cancer
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Diet high in nitrites and salt and low in fresh vegetables (antioxidants), H. pylori colonization, and chronic gastritis
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Risk factors for peptic ulcer disease
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H. pylori infection, corticosteroid use, NSAIDs, alcohol, and tobacco. Males > females
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Chronic or periodic dull, burning epigastric pain that improves with meals, worsens 2-3 hours after eating, and can radiate to the back
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Peptic ulcer disease
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Diagnostic study to evaluate for perforated peptic ulcer
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Abdominal X-ray (free air under the diaphragm). CBC to assess for GI bleed (decreased hematocrit)
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How do you rule out Zollinger-Ellison syndrome in patients with GERD or PUD that are refractory to medical management
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Serum gastrin levels
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Gastrin-producing tumors in the duodenum and/or pancrease
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Zollinger-Ellison syndrome
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Complications of peptic ulcer disease (acronym HOPI)
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Hemorrhage
Obstruction Perforation Intractable pain |
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Zollinger-Ellison syndrome is associated with what type of multiple endocrine neoplasia?
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MEN I
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Gnawing, burning abdominal pain with diarrhea, N/V, fatigue, weight loss, GI bleed, all of which is recurrent and unresponsive to treatment?
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Zollinger-Ellison syndrome
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Common cause of pediatric diarrhea
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Rotavirus infection
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Most common etiology of infectious diarrhea.
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Campylobacter
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Diarrhea that results from recent treatment with antibiotics (penicillins, cephalosporins, and clindamycin)
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Clostridium difficile
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Complication of clostridium difficile
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Toxic megacolon
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Treatment for C-diff
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Stop inciting antibiotic. PO metronidazole or vancomycin. If the pt can't tolerate oral medication, then IV metronidazole
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When does acute diarrhea require laboratory testing?
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If the patient has a high fever, bloody diarrhea, or diarrhea lasting >4-5 days
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Complication of entamoeba histolytica with administered steroids
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Can lead to fatal perforation
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Treatment for patients with celiac sprue
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Gluten-free diet
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Idiopathic bowel function disorder characterized by abdominal pain and changes in bowel habits that increase with stress and are relieved by bowel movements
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Irritable bowel syndrome
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A patient presents with abdominal pain, change in bowel habits (diarrhea or constipation), abdominal distention, stools with mucus, and pain relief with bowel movement. What diagnostic studies should be done?
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CBC, TSH, electrolytes, stool cultures, abdominal films, and barium contrast studies. Also, take a good history to determine the cause. The diagnosis of exclusion would be IBS.
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Dietary treatment for IBS
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Fiber supplements
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Most common cause of small bowel obstruction in adults
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Adhesions from a prior abdominal surgery
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Leading cause of small bowel obstruction in children
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Hernias
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Abdominal films show a stepladder pattern of dilated small bowel loops and air-fluid levels
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Small bowel obstruction
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Abdominal X-ray shows radiopaque material at the cecum
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Gallstone ileus
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The presence of lactic acidosis in small bowel obstruction indicates...
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Necrotic bowel: a surgical emergency
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Loss of bowel peristalsis without structural obstruction
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Ileus
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Abdominal X-ray shows distended loops of small and large bowel on supine x-ray and air-fluid levels on upright view
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Ileus
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What effect do anticholinergics, opioids, and hypokalemia have on GI motility?
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They slow GI motility
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Most common cause of acute GI bleeding in patients >40
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Diverticulosis
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Risk factors for diverticulosis
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Low fiber, high fat diet, advanced age, and connective tissue disorders
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Lower left quadrant pain, fever, nausea, vomiting, and constipation is likely...
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Diverticulitis
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Treatment of uncomplicated diverticular disease
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High fiber diet or fiber supplements
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Treatment for diverticulitis
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Bowel rest (NPO), NG tube, broad-spectrum antibiotics (metronidazole and a fluoroquinolone or a 2nd or 3rd generation cephalosporin) if the pt is stable. Avoid barium enema and flexible sigmoidoscopy.
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A patient has a large bowel obstruction. What should be assumed until proven otherwise?
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Colon cancer
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Barium enema study shows "bird beak" sign
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Large bowel obstruction
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Barium enema X-ray shows an "apple-core" filling defect in the descending colon
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Colon carcinoma
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GI manifestation of scleroderma (CREST syndrome)
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Esophageal dysmotility. May be the presenting complaint leading to the diagnosis of scleroderma
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Lower weblike constriction located at the squamocolumnar mucosal junction of the esophagus
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Schatzki's ring. Associated with GERD.
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Esophageal diverticula
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Zenker's diverticulum
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Gradual onset dysphagia, spontaneous regurgitation of undigested food, halitosis, neck mass on physical exam
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Zenker's diverticulum
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Dilated submucosal veins in the esophagus secondary to portal hypertension, seen in half of patients with cirrhosis
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Esophageal varices
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Management of esophageal varices
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Endoscopic evaluation with therapeutic banding or sclerotherapy of varix. If hemorrhage is too vigorous, balloon tube tamponade. Vasoconstrictive drugs (vasopressin, somatostatin).
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Superficial mucosal tear at the gastroesophageal junction
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Mallory-Weiss Tear
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Pharmacologic treatment of choice for peptic ulcer disease
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PPIs
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Iron deficiency anemia in an elderly male
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Colorectal cancer until proven otherwise
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Tumor marker in colorectal cancer, used to monitor recurrence
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CEA
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Type of inflammatory bowel disease in which the rectum is always involved
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Ulcerative colitis
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Type of IBD that may involve any portion of the GI tract
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Crohn's disease
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Colonoscopy reveals aphthoid, linear, or stellate ulcers, strictures, "cobblestoning", and "skip lesions"
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Crohn's disease
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Test to make a definitive diagnosis of either type of inflammatory bowel disease
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Biopsy
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Pharmacologic treatment for inflammatory bowel disease
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5-ASA agents (sulfasalazine, mesalamine), corticosteroids and immunomodulating agents (azathioprine, infliximab) if no improvement
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Curative treatment for long-standing ulcerative colitis or toxic megacolon
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Total colectomy
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Which has a higher risk of colon cancer: ulcerative colitis or Crohn's disease?
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Ulcerative colitis
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What are the structures that comprise Hasselbach's triangle?
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Inguinal ligament, inferior gastric artery, and the rectus abdominis
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Herniation of abdominal contents through the floor of Hasselbach's triangle
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Direct inguinal hernia
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Herniation of abdominal contents through the internal and then external inguinal rings and eventually into the scrotum (in males)
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Indirect inguinal hernia
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The most common hernia in both genders
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Indirect inguinal hernia.
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Etiology of indirect inguinal hernia
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Congenital patent processus vaginalis
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Risk factors for cholelithiasis
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4 F's: female, fat, fertile, forty (however it is common and can occur in any patient)
Also OCPs, rapid weight loss, positive family history, chronic hemolysis, small bowel resection, and TPN |
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Postprandial RUQ abdominal pain that radiates to the right subscapular area or the epigastrum
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biliary colic
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Inspiratory arrest during deep palpation of the RUQ
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Murphy's sign, indicative of cholecystitis
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Gallstones in the common bile duct
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choledocholithiasis
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Hallmark lab values in choledocholithiasis
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elevated alkaline phosphatase and total bilirubin
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Acute bacterial infection of the biliary tree that occurs secondary to obstruction, usually from gallstones
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Acute cholangitis
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Charcot's triad
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RUQ pain, jaundice, and fever/chills. Classic signs of acute cholangitis
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Reynold's pentad
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Charcot's triad plus shock and altered mental status. Signs of acute suppurative cholangitis; suggests sepsis
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An idiopathic disorder characterized by inflammation, fibrosis, and strictures of extra and intrahepatic bile ducts. Usually presents in young men with IBD, especially UC.
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Primary sclerosing cholangitis
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LFTs in hepatocellular injury
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Marked elevation of AST and ALT, mild elevation of bilirubin and alk phos
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70 year old with fatigue, no history of alcohol abuse or liver disease, no meds. PE shows scleral icterus. Lab reveals normocytic normochromic anemia, conjugated hyperbilirubinemia with bilirubin in the urine. Serum bilirubin is 12mg/dl with ALT and AST in the normal range. Alk phos is 3x the normal limit. Most likely diagnosis?
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Biliary obstruction. Confirm with an ultrasound or CT scan.
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LLQ abdominal tenderness to palpation associated with constipation and a low grade fever
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Acute diverticulitis
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Villous atrophy with with increased lymphocytes in the lamina propria is found on small bowel biopsy. Likely diagnosis?
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Ulcerative colitis
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Mucosal inflammation and edema with crypt abscesses are found on sigmoidoscopy. Likely diagnosis?
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Crohn's disease.
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If a patient has completed their hepatitis B vaccine series, what would you expect to find on their hepatitis profile?
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antibody against the hepatitis B surface antigen (anti-HBS)
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40 year old male has a history of 3 duodenal ulcers with prompt recurrence after medical treatment. Serum gastrin was reported as 200pg/ml. What test will confirm your diagnosis?
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Secretin injection test. The history fits the profile of Zollinger-Ellison syndrome. The secretin injection test will cause another increase in gastrin from a duodenal or pancreatic tumor.
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Initial treatment for Zollinger-Ellison syndrome.
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PPI. If this fails, then surgical resection. (Drug treatment is usually successful.)
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30 year old female has a 3 week history of diarrhea with blood and mucus. Colonoscopy reveals inflamed friable mucosa from rectum to midsigmoid. Biopsy reveals inflammation with erosions. Likely diagnosis?
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Ulcerative colitis
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32 year old female presents with 3 week history of diarrhea and RLQ abdominal pain. Biopsy findings reveal inflamed areas with nodular thickening especially at the terminal ileum. Likely diagnosis?
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Crohn's disease
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69 year old female smoker presents with a 3 week history of low grade fever and bloody diarrhea. Colonoscopy reveals continuous erythema in the colon only. Likely diagnosis?
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Ulcerative colitis. The combined risk factors of age (69) and smoking, with the presentation of low grade fever and the passage of blood is classic for ulcerative colitis.
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Differentiating sign between acute cholecystitis and acute cholangitis
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Acute cholangitis will have a fever as high as 105 (F). In acute cholecystitis, the fever rarely goes above 100 (F).
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An 18 year old male develops enteric hepatitis. Which hepatitis virus is the most likely cause?
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Hepatitis A. Fecal-oral transmission.
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On colonoscopy of a 50 year old asymptomatic man, a 0.5cm tubular adenoma was found and removed. When should he return for a repeat colonoscopy?
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3 years. In patients with only one polyp found and removed on initial exam, the optimal follow-up interval is every 3 years. In patients with no polyps on initial colonoscopy, a follow up interval of 5 years should be safe.
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What vitamin supplementation should be given to a patient with ulcerative colitis who is treated with sulfasalazine?
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Folate
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The most clinically useful marker for the presence of acute and chronic hepatitis B is...
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hepatitis B surface antigen
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LFTs in cholestasis
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Marked elevation of alk phos and bilirubin, with or without increased aminotransferases
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A clinical sign that arises when excess bilirubin (>2.5mg/dl) is circulating the blood
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Jaundice
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Prodrome of malaise, fever, joint pain, fatigue, URI symptoms, N/V, and change in bowel habits followed by jaundice and RUQ tenderness
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Acute hepatitis (viral)
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Sudden, steady epigastric pain, often radiating to the back, aggravated by walking and lying supine, relieved by sitting and leaning forward. May have mild jaundice and fever.
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Acute pancreatitis
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