Pance Gi

Front 1

Disease that is associated with primary sclerosing cholangitis? What antibody may be seen?

Back 1

Ulcerative colitis (70%)
+ p-ANCA (in 70%)

Front 2

What is budd-chiari syndrome?

Back 2

Occlusion of hepatic veins or IVC
Tx: heparin-->coumadin

Front 3

What is common hematologic cause of budd-chiari?

Back 3

polycythemia vera

Front 4

What triad of sx are classic for budd-chiari?

Back 4

hepatomegaly
RUQ pain
ascites

Front 5

What ratio distinguishes ascites in portal hypertension from non portal causes?

Back 5

SAAG=serum-ascities albumin gradient

SAAG>1.1 =portal hypertension

SAAG<1.1 = non-portal, peritonitis, cancer, hypoalbuminemia, pancreatitis

Front 6

What lab is seen in ascitic fluid in spontaneous bacterial peritonitis?

Back 6

>250 polys
+ ascites culture

Front 7

What lab distinguishes cirrhosis ascites from cardiac ascites?

Back 7

AFTP: ascites fluid total protein

AFTP <2.5 in cirrhosis
>2.5 in cardiac ascites

Front 8

What labs are seen in hemochromatosis?

Back 8

-HFE gene mutations
-Iron sat (iron/TIBC) >45%
- ^ Ferritin

Front 9

Labs seen in alcoholic hepatitis?

Back 9

AST: ALT > 2:1

Front 10

how do you determine if treatment is warranted in alcoholic hepatitis?

Back 10

Discrimination function = 4.6x (PT-control PT) + total bili

if >32 tx with prednisolone
if no infection, GI bleed

alt tx is pentoxifylline

Front 11

Cause of GERD?

Back 11

Sustained relaxation of lower esophageal sphincter.

Worse with increased abdominal pressure (pregnancy, obesity)

Front 12

Presentation of GERD?

Back 12

Heartburn or substernal pain 30-60 min after eating. Worse when lying down.
-May have nocturnal cough

Front 13

Complication of chronic GERD?

Back 13

Barrett's esophagus (growth of columnar epithelium)
-predisposition to develop adenocarcinoma

Front 14

Cause of achalasia?

Back 14

-Deffective LES nerve innervation
-Contacted LES with failure to relax
-Decreased peristalsis of lower 2/3 of esophagus

Front 15

Imaging findings in achalasia?

Back 15

-Esophageal manometry: absence of peristalsis
-Barium swallow: birds beak narrowing

Front 16

Dx: Progressive dysphagia to solids and liquids?

Back 16

Achalasia

Front 17

Imaging findings in esophageal spasm?

Back 17

Barium swallow: "corkscrew" or "rosary beads"

Front 18

What medications relieve chest pain in esophageal spasms?

Back 18

Nitro, CCB

Front 19

Dx: Esophageal webs associated with iron deficiency in middle aged women?

Back 19

Plummer-vinson syndrome

Front 20

Dx: Esophageal webs located at squamocolumnar junction

Back 20

Schatzkis ring

Front 21

Dx: weakness in posterior pharyngeal wall associated with regurgitation, dysphagia and halitosis

Back 21

zenkers diverticulum

Front 22

Medication therapies for esophageal varices?

Back 22

-Nadolol (chronic tx)
-Vasopressin, octreotide (vasoconstrictors)
-ABX in any cirrhosis patient with GI bleed (Ceftriaxone or norfloxacin)

Front 23

Varices develop at what portal vein pressure?

Back 23

>10 mmHg

Front 24

Dx: Vomiting followed by painful hematemesis?

Back 24

Mallory-Weiss Syndrome
(tear of mucosa at gastroesophageal junction)

Front 25

Most common cause of upper GI bleeding?

Back 25

PUD

Front 26

Three major causes of PUD?

Back 26

-H. pylori
-NSAIDS
-hypersecretory peptic states (Zollinger ellison syndrome)

Front 27

Dx: Benign gastrin secreting tumor usually located in pancreas causing PUD?

Back 27

Zollinger ellison syndrome

Front 28

How do NSAIDs cause GI injury?

Back 28

inhibits prostaglandin synthesis: decreased blood flow, bicarb synth, and mucus secretion

Front 29

Dx: Epigastric gnawing pain relieved with food, worse at night?

Back 29

duodenal ulcers

Front 30

Dx: Epigastric pain aggravated by food and associated with weight loss?

Back 30

gastric ulcer

Front 31

What is the triple therapy used to treat H. pylori infection?

Back 31

-PPI
-Clarithromycin
-Amoxicillin (Flagyl if PNC allergy)

x 2 wks

Front 32

Zollinger ellison syndrome is associated with what metabolic disease?

Back 32

MEN 1

Front 33

Testing used to confirm dx of zollinger ellison syndrome?

Back 33

-fasting serum gastrin (gold standard)
-gastric acid secretory studies
-secretin stimulation test
-somatostatin receptor scintigraphy

Front 34

Common findings in MEN1 (Wermer syndrome)?

Back 34

-Parathyroid tumor (hyper PTH,hypercalcemia)
-Gastrinoma (ZES)
-Insulinoma
-Prolactinoma
-Carcinoid tumor

Front 35

What 2 lymph node findings are consistent with gastric or abdominal cancer?

Back 35

sister mary joseph nodule (umbilical)
virchow's node (supraclavicular)

Front 36

What is the most common cause of secretory diarrhea?

Back 36

toxins from bacterial infection

(has normal stool ion gap in osm)

Front 37

What are common causes of osmotic diarrhea?

Back 37

celiac disease
laxative over use
lactose intolerance

(stool ion gap >100 osm)

Front 38

What are common causes of excretory diarrhea?

Back 38

Crohns
Ulcerative colitis

Front 39

What serologic tests confirm celiac sprue?

Back 39

IgA anti-endomysial and anti-tissue transglutaminase antibodies

Front 40

Skip lesions and granulomas are seen with what condition?

Back 40

crohns

Front 41

Dx: Currant jelly stools and sausage like mass on abd exam?

Back 41

intussusception

Front 42

Mucosal changes seen in crohns disease?

Back 42

skip lesions
cobblestoning

Front 43

What serum antibody is found in crohns disease?

Back 43

ASCA
(Anti-Saccharomyces cerevisiae antibodies)

Front 44

What serum antibody is found in ulcerative colitis?

Back 44

pANCA
(perinuclear antineutrophil cytoplasmic antibodies)

Front 45

Area of GI tract most commonly involved in ulcerative colitis?

Back 45

rectosigmoid colon

Front 46

Dx: Fever, LLQ pain, n/v, palpable mass

Back 46

diverticulitis

Front 47

Best diagnostic imaging for diverticulosis?

Back 47

barium enema

Front 48

ABX treatment for mild diverticulitis?

Back 48

flagyl + cipro or bactrim

Front 49

What marker in blood indicates infection with HepB and infectivity?

Back 49

HBsAg
and
HBeAg

Front 50

What marker in blood indicates successful clearance of HepB or immunization?

Back 50

anti-HBs

Front 51

What marker in blood indicates acute infection or relapse in chronic HepB?

Back 51

anti-HBc (IgM)

Front 52

What treatment should be given to patient exposed to HepB?

Back 52

Hep B immunoglobulin
(within 7 days of exposure)

Front 53

What exam findings are consistent with cirrhosis?

Back 53

gynecomastia
spider angiomas
palmar erythema
testicular atrophy
hepatomegaly
ascites

Front 54

What is a bluish discoloration of umbilical skin caused by hemoperitoneum in severe pancreatitis?

Back 54

cullen's sign

Front 55

What is an ecchymotic discoloration of the flanks found in hemorragic pancreatitis?

Back 55

Turner's sign

Front 56

What peptic ulcer is caused by CNS stress?

Back 56

cushings ulcer

Front 57

What peptic ulcer is caused by stress in a burn patient?

Back 57

curlings ulcer

Front 58

Test of choice for diagnosis of PUD?

Back 58

EGD with rapid urease test

Front 59

Top 6 causes of uppper GI bleed?

Back 59

1. PUD
2. Varices
3. Gastritis
4. Erosive esophagitis
5. Mallory-weiss tear
6. Arterio-venous malformations, angioectasias

Front 60

Rare cause of rectal bleeding and intussusception, usually presenting <2yo?

Back 60

Meckels diverticulum

Front 61

What is the rule of 2s in meckels diverticulum?

Back 61

-occurs in 2% of population
-located 2 feet from ileocecal valve
-usually in patients < 2 years old
-2 inches in length
-2x more common in males
-2 types of tissue common: gastric and pancreatic

Front 62

Diagnostic test for meckels diverticulum?

Back 62

technetium 99m scan

Front 63

What tests are used to dx C-diff colitis?

Back 63

Stool ELISA (toxins A and B
Stool cytotoxin assay (takes 24-48 hrs)

Front 64

What types of diarrhea have an increased osmotic gap?

Back 64

lactose intolerance
celiac disease
malabsorption disorders: pancreatic insufficiency, whipples disease

Front 65

What blood tests confirm dx of celiac disease?

Back 65

IgA antitissue transglutaminase
or
anti-endomysial antibody

Front 66

Dx: acute colonic adynamic ileus with competent ileocecal valve

Back 66

Ogilves

Front 67

Diagnostic study of choice for diverticulitis?

Back 67

Abdominal CT

Front 68

Dx: abdominal pain out of proportion to abdominal tenderness on exam

Back 68

mesenteric ischemia

Front 69

Most common cause of mesenteric ischemia?

Back 69

SMA embolism

Front 70

Imaging of choice in mesenteric ischemia?

Back 70

CT angiogram
Angiography (gold standard)

Front 71

What pancreatic enzyme is most specific for pancreatitis?

Back 71

Lipase

Front 72

Which type of diarrhea has an increased osmotic gap (>50)?

Back 72

osmotic: lactose intolerance, celiac disease, pancreatic insufficiency

Front 73

What cause of diarrhea has increased fecal fat?

Back 73

malabsorption: celiac disease, pancreatic insufficiency, whipples disease

Front 74

A stool osmotic gap <50 indicates what cause of diarrhea?

Back 74

secretory: carcinoid, zollinger ellison syndrome, hormonal causes

motility: irritable bowel syndrome, scleroderma

Front 75

Ransons criteria for pancreatitis at initial diagnosis?

Back 75

GALAW:
Glucose >200
Age >55
LDH >350
AST >250
WBC >16

Front 76

Jaundice is seen when serum bili reaches what level?

Back 76

>2.5

Front 77

Causes of unconjugated (indirect) hyperbilirubinemia?

Back 77

Overproduction: hemolysis, hematoma resorption, ineffective erythropoiesis

Defective conjugation: Gilberts syndrome, crigler-najjar syndrome

Front 78

Cause of Gilbert syndrome?

Back 78

Genetic deficiency of bilirubin-UGT enzyme. Decreased bili conjugation.

Front 79

Which antibodies are seen in acute and chronic HepB?

Back 79

Acute HepB: IgM
Chronic HepB: IgG

Front 80

What is the max recommended dose of tylenol per day?

Back 80

4g

Front 81

What is the toxic metabolite of tylenol?

Back 81

NAPQI

Front 82

Antidote for tylenol toxicity?

Back 82

N-acetylcysteine
(give up to 72 hrs after ingestion)
or later if chronic toxicity

Front 83

Chart which determines treatment and risk of hepatotoxicity in tylenol overdose?

Back 83

Rumack-Matthew nomogram

Front 84

What nail findings may be seen in cirrhosis?

Back 84

Muehrckes lines (horizontal white lines)

Terry's nails (white ground glass appearance)

Front 85

Most common organism cause of spontaneous bacterial peritonitis?

Back 85

gram negatives: E.coli, klebsiella

Front 86

Tx of encephalopathy?

Back 86

restrict dietary protein
lactulose
rifaximin

Front 87

Scoring system used to stage liver failure?

Back 87

child-turcotte-pugh

Front 88

Scoring system used to stage survival and patients need for liver transplant?

Back 88

MELD score

Front 89

Cause of hemochromatosis?

Back 89

genetic disorder causing iron overload and accumulation in liver

Front 90

Tx of hemochromatosis?

Back 90

phlebotomy weekly
Deferoxamine (binds iron)

Front 91

Dx: genetic disorder causing copper overload and accumulation in liver?

Back 91

wilsons disease

Front 92

Eye finding in wilsons disease patients?

Back 92

kayser-fleischer rings

Front 93

Tx of wilsons disease?

Back 93

chelation: penicillamine + pyridoxine

Zinc (decreases copper transport)

Front 94

Most common type of gallstone?

Back 94

cholesterol

Front 95

Tx for choledocolithiasis?

Back 95

ERCP
cholecystectomy 6wks later

Front 96

Imaging that is more sensitive for cholecystitis than US?

Back 96

HIDA scan

Front 97

What is charcots triad and reynalds pentad?

Back 97

Charcots: fever, jaundice, RUQ pain
Reynalds: above + altered mental status, shock

sx associated with cholangitis

Front 98

Infectious cause of diarrhea that is also associated with development of Guillian-barre syndrome?

Back 98

Campylobacter

Front 99

ABX of choice for severe campylobacter diarrhea?

Back 99

erythromycin

Front 100

Initial rx of choice for inflammatory bowel disease?

Back 100

Sulfasalazine

Front 101

Prolonged use of PPIs can lead to reduced levels of what nutrient?

Back 101

Vit B12