D\'s GI Step 2

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JCremer
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29311
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D\'s GI Step 2
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2010-08-08 13:50:02
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  1. Poultry
    • Campylobacter jejuni
    • Salmonella
  2. Bloody diarrhea
    • 1. Camplobacter jejuni
    • 2. E Coli (0157:H7-enterohemorrhagic)
    • 3. Salmonella
    • 4. Shigella
    • 5. Yersinia
    • 6. C diff
    • 7. E histolytica
  3. Pseudoappendicitis
    Yersinia
  4. Treating Hep C
    IFN alpha & ribavirin
  5. Treating Hep B
    Peg IFN alpha or antivirals

    (lamivudine, adefovir, entecavir, telbivudine)
  6. Vaccination for Hep B
    + anti-HBs
  7. Impaired peristalsis &  LES relaxation
    Achalasia
  8. Progressive dysphasia solids & liquids. Barium swallow: birds beak. Diagnosis? Manometry? Next step?
    Achalasia

    •  LES presure
    • Incomplete LES relaxation
    •  Peristalsis

    EGD to R/0 malginancy
  9. Treatment of Achalasia:
    • Nitrates
    • CCB
    • Pneumatic dilation
    • Botox
    • Myotomy (butGERD)
  10. Corkscrew barium swallow. diagnosis? Treatment?
    Diffuse Esophageal Spasm

    CCB, nitrates, TCA's
  11. Regurgitation of food days after eating, halitosis, dysphagia. Diagnosis? Treatment?
    Zenker Diverticulum

    • Cricopharyngeal myotomy
    • Diverticulectomy
  12. Low pressure in LES, test for dx?
    GERD

    Esophageal pH monitoring
  13. Barrett's esophagus
    Columnar metaplasia of distal esophagus
  14. Labs for gastritis
    • + Urea Breath Test
    • + IgG antibody H. pylori
    • Ratio of pepsinogen- AI
    • Antral Biopsy
  15. Type A Chronic Gastritis: site, path, labs, associations
    • Site: fundus
    • Path: autoantibodies to parietal cell
    • Labs: Gastric H, Gastrin
    • Associated: PA, achlorhydria, thyroidiyis
  16. Type B Chronic Gastritis: site, path, labs, associations
    • Site: Antrum
    • Path: H. Pylori
    • Labs:  Gastric H
    • Associated: PUD, Gastric Ca
  17. Treating H. pylori:
    PPI, clarithromycin, amox or metronidazole x7-14 days
  18. Free Air under diaphragm
    Perforation: of PUD
  19. Posterior Ulcers
    Hemorrhage via gastroduodenal artery
  20. Anterior Ulcers
    Perforation
  21. Barium swallow suggesting malignancy:
    • 1. Abnormal appearing mucosal folds
    • 2. Mass near ulcer
    • 3. Irregular filling defects in ulcer base
  22. Gastrin producing tumor
    Zollinger Ellison
  23. Refractory PUD, abd pain, nausea, vomiting, diarrhea, steatorrhea.
    ZE
  24. Labs ZE
    •  fasting gastrin
    • + secretin-stimulation test
    • Specific gastrin sampling
    • SPECT
    • Angiography
  25. + secretin stimulation test
    Administration of secretin caises higher than expected serum gastrin levels

    (ZE)
  26. M. Gastric cancer
    Adenocarcinoma
  27. Types of Gastric Cancer:
    • Ulcerating: PUD-like
    • Polypoid: large, intraluminal
    • Superficial Spreading: mucosa & submucosa only, best prognosis
    • Linitis plastica: all layers,  elasticity, worst
  28. Risk factors for Gastric Cancer:
    • 1. H pylori
    • 2. FH
    • 3. Japanese 
    • 4. 
    • 5. 
    • 6. Vit C deficiency
    • 7.  preserved foods
    • 8.  > 
  29. Barium swallow showing thick leather bottle stomach
    Linitis plastica
  30. Ranson's Criteria on admission
    • G: Glucose >200
    • A: AST > 250
    • L: LDH > 350
    • A: Age > 55
    • W: WBC >16,000
  31. Ranson's criteria during initial 24 hrs
    • C: Calcium <8
    • H: Hct decrease >10%
    • O: O2 <60mmHg
    • B: BUN increase >5mg/dL
    • B: Base deficit >4mEq/L
    • S: Sequestration of fluid >6 L
  32. Pancreatic pseudocyst
    Fluid collection arising from pancreas consisting of enzyme rich fluids contained in a sac of inflammed membranous tissue.
  33. Labs on pancreatic pseudocyst:
    •  WBC
    •  amylase
    • Aspiration =  amylase
    • US/CT: pseudocyst
  34. Drain a pseudocyst if:
    • 1. Lasting > 6wks
    • 2. Painful
    • 3. Rapidky growing

    (usually self resolves)
  35. Grey turners sign
    Bluish discoloration of flank

    Seen in acute pancreatitis
  36. Cullens sign
    Periumbilical discoloration

    Seen in acute pancreatitis
  37. Sentinel Loop on AXR
    Acute pancreatitis

    Dilated loop of bowel near pancreas
  38. Colon cutoff sign on AXR
    Acute pancreatitis

    R colon distended until near pancreas
  39. Chain of lakes on AXR
    Chronic pancreatitis

    Calcifications
  40. Exocrine pancreatic cancer
    • Adenocarcinoma if pancreas
    • MC-pancreatic head
  41. Endocrine pancreatic cancer:
    • ZE
    • Insulinoma
    • Glucagonoma
    • VIPoma
  42. Courvoisier's sign
    Palpable, nontender gallbladder

    Exocrine pancreatic cancer
  43. Tumor markers for pancreatic exocrine cancer:
    • CEA
    • CA 19-9
  44. Treatment for pancreatic exocrine ca:
    • Nonmet dz pancreatic head: whipple
    • Lesion body/tail: subtotal pancreatectomy (if early)
    • Advanced dz: stent pancreatic ducts, biliary ducts, duodenum
  45. Migratory thrombophlebitis
    Trousseaus's syndrome

    Seen in pancreatic cancer
  46. Hypoglycemia symptoms with fasting, hypoglycemia, improvement of symptoms with carb loading. Dx?
    Insulinoma

    (whipples triad)
  47. Positive C peptide, increased fasting insulin, spontaneous hypoglycemia
    Insulinoma
  48. Localize insulinoma with what tests:
    • CT
    • US
    • Indium labeled ocreotide scintigraphy
  49. Treat insulinoma
    • Surgery
    • Diazoxide
    • Ocreotide
  50. Migratory necrolytic erythema
    Glucagonoma
  51. Hyperglycemia, increased glucagon
    Glucagonoma
  52. Treatment for glucagonoma
    • Surgery if localized
    • Ocreotide
    • IFN alpha
    • Chemo
    • Embolization:

    Poor prognosis
  53. Watery diarrhea, nausea, vomiting, abd pain,VIP
    VIPoma
  54. Treatment for VIPoma
    • Surgery if localized
    • Steriods
    • Chemo
    • Ocrtreotide
    • Embolization
  55. Foul, green diarrhea in the winter
    Rotavirus
  56. Diarrhea associated with cruises
    Norwalk virus
  57. Thrombocytopenia, hemolytic anemia, acute renal failure
    HUS from E. Coli
  58. Treat b. Cereus gastroenteritis
    • Hydration
    • Self limited
  59. Treating C. Jejuni gastroenteritis
    • Erythromycin
    • Hydration
    • Self limited
  60. C. Botulinum gastroenteritis
    Botulism Antitoxin
  61. C diff gastroenteritis tx
    • Metronidazole
    • Vancomycin
  62. E coli gastroenteritis tx
    • Hydration
    • Self limited
    • Antibotics may worsen
  63. Staph aureus gastroenteritis tx:
    • Hydrate
    • Self limited
  64. Salmonella gastroenteritis treatment
    • Hydrate
    • Self limited

    If immunocompromised can give fluroquinolones but can prolong carrier state
  65. Shigella gastroenteritis treatment
    • Hydrate
    • Self limited
    • Cipro or bactrim if severe
  66. Vibrio cholera gastroenteritis treatment
    • Hydrate
    • Pedialyte
    • Tetra or doxycycline
  67. Vibrio parahaemolyticus gastroenteritis treatment
    • Hydration
    • Self limited
  68. Yersina gastroenteritis treatment
    • Hydration
    • Self limited
  69. gastroenteritis with vomiting within several hrs of eating, diarrhea later
    Staph aureus
  70. gastroenteritis with. Flaccid paralysis
    C. Botulinum
  71. Copious watery diarrhea, signs of dehydration
    Vibrrio cholerae
  72. Puppy feces gastroenteritis
    Yersina
  73. gastroenteritis where u MuSt wash hands
    C diff
  74. Greasy foul smelling diarrhea, cysts trophozoites in stool
    Giardia lamblia
  75. Treatment of giardia
    • Metronidazole
    • Hydration
  76. Severe bloody diarrhea with cysts and trophozoites seen in still, liver abscess
    Entamoeba histolytica
  77. Entamoeba histolytica treatment
    Metronidazole
  78. Watery diarrhea in immunocompromised
    • Cryptosporidium parvum
    • Isospora
  79. Cryptosporidium parvum treatment
    • Control immune supression
    • Nitazoxanide
  80. Undercooked pork & diarrhea
    • Trichinella spiralis
    • Taenia solium
  81. Fever myalgia, periorbital edema, eosinophilia, diarrhea, undercooked 
    Trichinella spiralis
  82. Treat Trichinella spiralis
    • Albendazole
    • Mebendazole
  83. Mild diarrhea, CNS symptoms, undercooked , sz, death
    Taenia solium
  84. Taenia solium treatment
    • Praziquantel: if GI sympt only
    • Albendazole & corticosteriods: if neuro symptoms
  85. MC neoplasm of salivary gland
    Pleomorphic adenoma (benign)
  86. Esophageal fibrosis due to
    • Radiation
    • Alkali ingestion
    • Iron OD
  87. MCC esophageal cancer worldwide, US?
    • Worldwide: squamous cell ca
    • : adenocarcinoma
  88. Paraesophageal hernia more likely to
    Become ischemic and incarcerated
  89. Timing of pain gastric vs duodenal ulcer?
    Gastric: soon after eating, food may worsen symptoms

    Duodenal: 2-4hr after eating, food may help initially
  90. H pylori in ~75% what ulcer type?
    Duodenal Ulcer
  91. Lab best for chronic pancreatitis
     fecal elastase
  92. Food poisoning from mayonnaise sitting out too long
    Staph aureus
  93. Rice water stools
    • V. Cholera
    • E. Coli
  94. MCC traveler's diarrhea
    E coli
  95. Diarrhea & recent ingestion of water from a stream
    • Giardia
    • Entameba histolytica
  96. Neurocysticercosis
    T. Solium
  97. Undercooked  & food poisoning
    E coli enterohemorrhagic
  98. Diarrhea & pink eye
    Adenovirus
  99. What anatomical structures in GI tract can be seen by barium swallow
    • Esophagus
    • LES
    • Stomach
  100. What anatomical structures in GI tract can be seen by gastric emptying study
    • Stomach
    • Pyloric sphincter
    • Duodenum
  101. What anatomical structures in GI tract can be seen by small bowel follow through (SBFT)
    Stomach to terminal ileum
  102. What anatomical structures in GI tract can be seen by barium enema:
    Colon & appendix
  103. Mallory Weiss vs Boerhaave
    • MW: mucosal laceration
    • B: esophageal perforation 

    Both have blood with emesis
  104. Surgical connection stomach to skin of abd wall for feeding
    Gastrostomy
  105. Surgical connection of the ileum to the skin of the abdominal wall
    Ileostomy
  106. Surgical connection of the colon to the skin of the abdominal wall
    Colostomy
  107. Surgical incision into abdominal cavity
    Laporotomy or Ceilotomy
  108. Types of esophageal diverticulum
    • Zenker: upper
    • Traction: mid
    • Epiphrenic: lower
  109. +hepBsAg only
    Vaccination
  110. + hepBsAb & + hepBcAb & -Hep BsAg
    Recovered
  111. EGD with biopsy shows gastric cancer. Next step?
    CT abd & pelvis to stage
  112. Next Step in management in pt with recurrent duodenal ulcers on at least 2 EGDs
    Serum Gastrin

    Rule out ZE
  113. Antibodies in Celiac
    • Antiendomysial
    • Antigliadin
  114. Treatment of tropical sprue
    • Folic acid replacement
    • Tetracycline

    Removing dietary gluten has no effect!
  115. Causes of lactose intolerance
    • Deficiency of lactase
    • Crohns disease
    • Bacterial overgrowth
  116. Type of diarrhea in lactose intolerance pts
    Osmotic
  117. Tests for lactose intolerance
    • +lactose intolerance test
    • +lactose breath hydrogen test
  118. What is a + lactose intolerance test
    Minimal increase in serum glucose following ingestion of lactose
  119. Jejunal biopsy shows foamy macrophages on PAS stain and villous atrophy
    Whipple dz
  120. Treatment of whipple dz
    TMP/SMX

    Ceftriaxone for 1 yr!!
  121. Symptoms of Whipple
    • Wt loss
    • Joint pain
    • Abd pain
    • Diarrhea
    • Dementia
    • Cough
    • Steatorrhea
    • Fever
    • Vision
    • Lymphadenopathy
    • New murmur
    • Severe wasting
  122. Sudan stain detects
    Steatorrhea
  123. Normal D xylose, abnormal Sudan stain
    Pancreatic insufficiency
  124. Sudan stain & abnormal d xylose test
    • Sprue
    • Whipples
    • Bacterial overgrowth
  125. Acute diarrhea, High fever, bloody > 5 days
    • Protozoan
    • Bacterial
    • Parasitic
  126. Types of chronic diarrhea
    • Secretory
    • Osmotic
    • Inflammatory
  127. Normal osmotic gap 50
    • Secretory:
    • VIPoma
    • Gastrinoma
    • Medullary thyroid cancer
    • Carcinoid tumor
    • Resection of ileun
  128. Secretory diarrhea mediated?
    Hormone
  129. High osmotic gap >50 or 125
    Osmotic diarrhrea
  130. Causes of osmotic diarrhea
    • Malabs
    • Panc insufficency
    • Whipple
    • Celiac
    • Tropical sprue
    • Lactase def
    • Lacutlose
    • Milk mag
    • Alumjmum
    • Sorbitol
  131. Irregular bowel habits, frequency, form of stool, abd pain
    IBS
  132. Treat iBS
    • High fiber
    • SSRI or TCA
    • Fiber bulking agents with hydration
    • Loperamide or alosetron
  133. HLA B27
    • Psoriatic Arthritis
    • A.S.
    • Inflamm bowel dz
    • Reiters
  134. Skipped lesions, string sign
    Crohns
  135. Gum to bum IBD
    Crohns
  136. Cobblestoning IBD
    Crohns
  137. Perianal fissures and fistulas in IBD
    Crohns
  138. Treating crohns
    • 5ASA: mesalamine, sulfasalazine
    • Azathioprine or mercaptopurine >methotrexate
    • Anti TNF alpha: infliximab
    • Steriods
    • Sx resection if severe
    • Immunosupressives
  139. Complications of Crohn
    • Abscess
    • Fistula
    • Fissure
    • Toxic megacolon
    • Malabsorption
  140. Rectum & distal ileum in IBD
    UC
  141. Bloody diarrhea continous IBD
    US
  142. Extraintestinal manifestations more common in which IBD
    Crohns
  143. Lead pipe in IBD
    UC
  144. Colectomy is curative in which IBD
    UC
  145. Increased risk of colon cancer which iBD
    UC
  146. Top 3 causes of small bowel obstruction
    • A: Adhesions
    • B: Buldge-incarcerated hernia
    • C: Colorectal Ca with mets
  147. Hyperactive high pitched bowel sounds, nausea, vomiting, abd pain. Dx?
    Small Bowel Obstruction
  148. Distended loops of small bowel on AXR
    Small bowel obstruction
  149. Treating SBO
    • NPO, IVF, electrolytes, foley
    • NGT with LIWS
    • Void pain meds!
    • Laparotomy
  150. What would lead you to do a laparotomy for SBO?
    • No impeovement 12-24 hrs
    • Conplete SBO
    • Suspected, impending, or ongoing strangulation
  151. MC benign small bowel tumor? Malignant?
    Leiomyoma

    Adenocarcinoma
  152. MCC small vs large bowel obstruction?
    Small: adhesions

    Large: neoplasm
  153. AXR ladder like dilated loops of bowel, air-fluid levels
    SBO
  154. AXR bowel distention proximal to obstruction
    LBO
  155. Air within bowel wall & bowel wall thickening
    Ischemia!

    Ischemic colitis
  156. Vague abd pain, n/v, no BM,  BS. Recent sx. Diagnosis?
    Ileus
  157. Treatment of Ileus
    • Stop opiods
    • NPO
    • Colonic deconpression
    • Erythromycin- motility
    • Neostigmine
    • Metoclopramide
  158. Elderly female with. Vague, recurrent abd pain & vomiting.
    Gallstone Ileus

    Gallstone impacted in ileum through biliary-enteric fistula
  159. MC location of volvulus
    Cecum & sigmoid colon
  160. AXR of volvulus? Barium enema?
    • AXR: double bubble
    • Barium enema: birds beak
  161. Treatment for sigmoid volvulus
    Sig/colonoscope decompress

    CI if signs of gangreneperf
  162. Recent Cuban immigrant for symptoms of malabsorption with megaloblastic anemia. Dz? Tx?
    Tropical Sprue

    • Folic H
    • Tetracycline or sulf 3 mo's
  163. Time frame for post-op ileus resolving in: SB, stomach, LB?
    • SB: 1 day
    • Stomach: 2-3 days
    • LB: 3-5days
  164. Signs for appendicitis
    • Psoas
    • Obturator
    • Rovsing
    • Tender @ McBurney's pt
  165. Psoas sign
    Pain on psoas on pasive hip extension
  166. Obturator's sign
    RLQ Pain with passive rotation internally of flexed hip
  167. Rovsings sign
    RLQ pain with LLQ palpation
  168. Most sensitive test for appendicitis
    • CT with contrast
    • Rectal>oral>without>plain film
  169. Classic characteristic of acute mesenteric ischemia?
    Pain out of proportion to exam
  170. Serum lab findings distinguishing Crohn's & UC
    • C: + ASCA
    • UC: + p ANCA
  171. MCC of acute lower GIB
    Diverticulosis
  172. LLQ pain, n/v, melena, hematochezia, AXR: free air under diaphragm
    Diverticulitis
  173. Mild early cases of diverticulitis treated how?
    • Bowel Rest
    • PO antibiotics-pick one
    • Fluoroquinolone & flagyl
    • Bactrim & flagyl
    • Augmentin
  174. Inpatient tx of diverticulitis for:
    • Elderly
    • Immunocompromised
    • Significant comorbities
    • High fever
    • Significant leukocytosis
    • Unabke to tolerate po intake
  175. If diverticulitis pt with guarding, rebound tenderness. Next step?
    Emergency exploration!

    (signs of peritonitis)
  176. 65 yr old female to ER with severe abd pain, WBC, abscess in region of sigmoid colon. Predisposing condition? Next step?
    Diverticulosisdiverticulitis abscess

    • CT/US guided percutaneous drainage
    • IV antibiotics
  177. Int vs Ext Hemorrhoids
    I: Superior rectal vein, above pectinate line, painless

    E: Inferior rectal vein, below pectinate line, painful
  178. Painful bleeding tears in posterior wall of anus. Dx? Tx?
    Anal fissure

    • Stool softener
    • Topical-nitro
    • Topical-dilt, nefedi,bethanechol, botox
    • Sphincterectomy
  179. Anorectal abscess tx
    • Antibiotic
    • I&D
  180. Rectal fistula/fistula in ano tx
    Fistulotomy

    Often found in crohn's
  181. Pilonidal dz tx?
    • I&D
    • Surgical closure of sinus tracts
  182. Carcinoid tumor arises from
    • Neuroectoderm cells
    • (APUD)
  183. Carcinoid tumor MC located? Other locations?
    Appendix!

    • Ileum
    • Rectum
    • Stomach
    • Lungs-bronchogenic ca
    • SB
  184. Carcinoid syndrome symptoms:
    • B: Bronchospasm
    • F: Flushing
    • D: Diarrhea
    • R: R sided  murmurs (tri/pulm)
  185. Localize carcinoid tumor by? Elevated levels of?
    CT/indium labeled octreotide Scintigraphy

    5 HIAA & Serotonin
  186. Carcinoid Syndrome only seen if:
    • Liver mets or
    • Extragastrointestinal involvement
  187. Treatment for Carcinoid Syndrome
    • Somatostatin: ocretotide
    • Cyproheptadine: diarrhea & anorexia
    • Albuterol/theo: asthma sx
    • Codeine/cholesytramine: diarrhea
  188. If carcinoid symptoms refractory to ocreotide..
    Add IFN alpha
  189. Sx indications for Carcinoid tumor
    • 2cm: resect
    • 2cm: extensive resection
    • Mets: IFN alpha, ocreotide, embolization
  190. Colon cancers associated with mutation of APC gene
    • FAP
    • Gardner's
    • Turcot
  191. Hyperplastic polyp
    Noncancerous!!
  192. Risk factors for colon cancer? MC kind?
    Adenocarcinona

    • 1.FH
    • 2.UC
    • 3.Colonic polyps
    • 4.Hereditary Polyposis synd.
    • 5.fiberfat diet
    • 6.Previous Colon Ca
    • 7.
    • 8. 
    • 9. DM
  193. Colorectal cancer mets MC to?
    • Lung
    • Liver
  194. Apple core lesion on barium enema
    Colorectal Cancer
  195. Duke's staging corresponding to lymph nice involvement in colorectal cancer
    Stage III
  196. Crigler Najjar syndrome deficiency of?
    Glucuronsyltransferase

    (conjugates bilirubin)
  197. Treatment of crigler najjar
    • Phototherapy
    • Plasmapheresis
    • Caphos & orlistat
    • Liver transplant
  198. Crigler Najjar symptoms
    • Perisitent jaundice
    • CNS symptoms

    Bilirubin 5
  199. Projectile emesis wks after birth, palpable olive shaped mass. Dx, test, tx.
    Pyloric stenosis

    • Barium swallow, US
    • String sign,  pyloric mm thickness

    Pyloromyotomy
  200. Electrolytes in pyloric stenosis
    • Metabolic Alkalosis
    •  K  Cl
  201. Air in bowel wall, bowel distension, hematochezia, preterm baby, bilious vomiting with poor feeding and diarrhea
    Necrotizing Enterocolitis
  202. Treatment of Necrotizing Enterocolitis.
    • TPN
    • IV antibiotics
    • NG suction
    • Resection of affected bowel

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