PANCE Flashcards Gastroenterology GI

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Fat, forty, female, fertile w/ RUQ pain Cholelithiasis or Cholecystitis
Fever, RUQ pain, radiation to back Cholecystitis

Elevated Alkaline phosphatase, urinary bilirubin

Cholecystitis

F, RUQ pain, Jaundice, gallstones & dilated common duct on US

Ascending cholangitis (Charcot’s triad)
Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation)
Elevated AST, ALT, indirect bilirubin hepatitis
Isolated elevated indirect bilirubin Gilbert’s syndrome
Elevated indirect bilirubin w/ defective glucuronyl transferase Crigler-Najjar Dz
Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility porphyria
H.pylori gastritis 2antibiotics & PPI
Chronic cough, bitter taste in mouth or throat, dyspepsia GERD
Multiple or constant GI ulcer pain despite medications Zollinger-Ellison Syndrome

Peri-umbilical or flank ecchymosis

Acute pancreatitis (Cullen & Grey Turner’s Sign)
N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals Acute pancreatitis
Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles SBO
Air fluid levels on upright abd plain film SBO
Air under diaphragm, rigid board-like abdomen Perforated viscus, perforated ulcer
>60yo F, LLQ pain Diverticulitis. IV Abx, fluids, NPO.
Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial Mesenteric ischemia
Neonate w/ projectile vomiting. Olive sized mass. Pyloric stenosis
Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life Tracheoesophageal fistula
Painless rectal bleeding in pediatrics Meckel’s diverticulum
Alcoholic with massive hemoptysis Esophageal varicies (Tx w/ octreotide)
Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation. IBS. TCA’s (nortriptyline) good if diarrhea predominant symptom
Bloody Diarrhea Ulcerative colitis
Supraclavicular LAD (L > R) Virchow’s node – metastatic abdominal cancer
Hard periumbilical nodule Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers
PUD, Pernicious anemia (Type A Gastritis), H. pylori Gastric Ca
Apple core lesion Colon Cancer
Elderly with positive hemmocult. Colon Cancer – get colonoscopy
CEA Colon Carcinoma
Family history of young age colon cancer, multiple polyps found on colonoscopy Familial adenomatous polyposis (Gardner’s syndrome)
AFP Hepatocellular carcinoma, testicular seminoma (germ cell tumor)
CA 19-9 Pancreatic Ca
CA-125 Ovarian Carcinoma
Chemotherapy induced N&V Treat with Ondansetron (Zofran) (5-HT3 blockers)
Traveler’s Diarrhea E. coli is cause. Hydration & Cipro to treat
Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history Giardia
Afebrile, watery or loose stool. No blood or mucus Viral Gastroenteritis
Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise Staphylococcus aureus infectious diarrhea
Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea Campylobacter jejuni – most common cause of acute bacterial diarrhea
Painless rectal bleeding. Bulging perianal mass w/ straining Internal hemorrhoids
Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test Pruritis ani – Pinworms (enterobiasis). Tx is Mebendazole
Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods Celiac Sprue
Anti-endomysial antibodies Celiac Sprue
Beriberi Thiamine; Alcoholics, Neuro Sx
Pellagra Niacin (4D’s dermatitis, diarrhea, dementia, death), bright red tongue
Scurvy Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling)
Rickets Vit D (Osteomalacia)
Night blindness Vit A deficiency
Magenta tongue Riboflavin deficiency (B2)
s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding Dumping syndrome
crampy abdominal pain, increased high pitched bowel sounds, gas only in the small intestine
Small bowel obstruction
gas with obstipation and failure to pass flatus
Paralytic ileus
hypocalcemia in ESRD
deficiency of vitamin D
somatostatin receptor scintography
ze study of choice
Two top causes of hypercalcemia
Primary hyperparathyroidism and malignancy account for 90% of all cases of hypercalcemia. Ten to twenty percent of patients with cancer develop hypercalcemia, most commonly because of breast, lung, kidney, head and neck carcinomas, and multiple myeloma and lymphoma.
soft tissue thickening of the pericolic fat, diverticula, and thickening of the bowel wall
CT findings consistent with diverticulitis
haustral markings
haustral markings= LARGE BOWEL.
cause of LBO
cancer, diverticulum, volvulus
causes of SBO adhesions, hernia
Rx indicated for prevention of NSAID ulcers
omeprazole
Trx systemic htn/ascites
start sprinolactone. if refractory can do paracentesis or tips
the best visualization of an esopahgeal web or ring.
barium esophagram
Barium studies contraindication patients with a possible perforation
acute performation perform hartmann procedure, if scheduled colectomy and primary anastomosis is considered.
PUD imaging upper endoscopy
absence of ganglion cells in the colon and typically presents early in life with failure to pass meconium, followed by vomiting and abdominal distension.
Hirschsprung disease
pyloric stenosis imaging
upper GI with barium
inner tube or coffee bean on imaging
volvulus
The treatment of choice for diarrhea caused by Giardia
metronidazole 250 to 750 mg po three times per day.
cholera DOC doxycycline or tetracycline
drug used to treat Campylobacter. Erythromycin
drug used to treat cholera and shigellosis. Quinolones
at what size do cecal obstructions require surgery
>12cm require surgical intervention
d/c what drug prior to fecal and urea breath testing.
no PPI 1-2 weeks prior to fecal and urea breath testing.
increased serum ammonia
asterixis; consider hepatic encephalopathy- give lactulose
autoimmune heptatitis
corticosteroids
Celiac diet (abstain from eating)
BROW: Barley Rye Oats Wheat
lead pipe colon, thumbprinting, loss of haustral markings ulcerative colitis
Double bubble on Xray
represents duodenal atresia (related to Down Syndrome)
most common complication associated with acute pancreatitis. Pancreatic pseudocysts suspected for a patient who has continued abdominal pain, the development of an abdominal mass, and continued elevations of amylase or lipase levels following an episode of acute pancreatitis.
alendronate (fosamax), which is known to cause what ADR esophagitis
hypochloremic alkalosis with potassium depletion.
pyloric stenosis
hallmark of peptic ulcer disease
Dyspepsia (epigastric pain)
variceal hemorrhage prophylaxis
Beta blocker
affects women typically between ages 40 and 60. It is often discovered incidentally when the serum alkaline phosphatase level is found to be elevated.
Primary biliary cirrhosis
Calcification of the gall bladder, frequently referred to as a porcelain gall bladder, and single, solitary, large, gall stone gall bladder cancer
A significantly elevated PT/INR as well as bilirubin > 10 mg/dl indicators of severe alcoholic hepatitis and increased mortality requiring hospitalization
hematemesis with severe retrosternal tearing pain boerhaave's syndrome- get esophogram and emergent surgical consult
esophagram with "birds beak" achalasia- tx botox, myotomy
smooth circumferential structure in the distal esophagus schatzki ring- get esophagram
dysphagia with regurgitation of food especially in the am; older patients zenker's diverticulum; get barium esophagram, surgery in severe cases
esophageal web may develop from what deficiency? iron deficiency (plummer vinson syndrome)
when to take PPIs take 30 minutes before meals
complication of GERD barrett's esophagus (which has an increased risk adenocarcinoma); tx long term PPI
serum gastrin level >150 consider ZES
ulcer disease- weight loss versus weight gain GUS- weight loss DUS- weight gain
two main causes indirect unconjugated bilirubinemia hemolysis, inherited (gilbert, crigler)
biliary colic, n/v, jaundice, ELEVATED LFTs choledolithiasis
fever, RUQ pain, jaundice charcot's triad
risk of pancreatitis with what procedure ERCP
women (40-50) with fatigue, jaundice, pruritis, hepatomegaly, elevated alk phos, AMA + Primary biliary cirrhosis; treat with bile acid sequestrant, cure is transplant
Gold standard dx biliary cirrhosis liver biopsy
womean 30-50 with fatigue, anorexia, arthralgias, +ANA, +ASMA Autoimmune hepatitis, get liver biopsy
fatigue, jaundice, pruritis, pain; associated with ulcerative colitis primary sclerosing cholangitis
nontender palpable gall bladder with hx weight loss klatskin tumor/cholangiocarcionoma
rx causes acute pancreatitis azothioprine, pentamide, valproate, thiazides
Ranson Criteria At admission: "GA LAW" (Glucose 200, Age>55, LDH >350, AST>250, WBCcount>16)
* At 48 hours: "C HOBBS" (as in Calvin and Hobbes): (Calcium, Hematocrit, O2, BUN, Basedeficit, Sequestration (of fluid) greater than 6 L
most common cause chronic pancreatitis alcohol abuse
-other causes CF, hyperparathyroidism, hx acute panc.
imaging of choice chronic pancreatitis CT- look for calcifications
most common location pancreatic cancer head
increased % transferrin sat hemochromatosis (autosomal recessive)
low serum ceruloplasmin, increased urine copper wilson's disease, treat with penicillamine
icterus, jaundince, malaise with ALT>AST (20x) Viral hepatitis
chronic hep B carriers are at risk for what? HCC
most common blood bourne infection hepatitis C
leading cause of chronic liver failure hepatitis C
diagnosis of hepatitis C screen with EIA, if positive use RIBA to confirm
hepatitis C treatment interferon plus ribavirin
factor that impact hep C trx genotype, race (AA males less likely to respond)
most common cause cirrhosis alcoholic hepatitis
non alcoholic versus alcoholic liver disease if AST/ALT >2.0 think ALCOHOL
most common metastatic cancer hepatocellular cancer
most common location crohn's disease terminal ileum
spares the rectum crohn's disease
skip lesions crohn's disease
colicky RLQ pain, diarrhea, low grade fever, weight loss crohn's disease
string sign crohn's disease
cobblestoning crohn's disease
what is malabsorbed with crohn's disease vitamin B12 and Fat
most common complication crohn's disease fistula
medical management crohn's disease mesalamine, sulfasalazine; azathioprine; biologics (Humira)
>50 y/o with hx atherosclerotic disease sudden severe abdominal pain; post prandial mesenteric ischemia
celiac sprue diet (CAN EAT) CRAP (corn, rice, arrowroot, potatoes)
dematologic manifestation celiac sprue dermatitis herpetiformis (pruritic papulovesicles over extensor surfaces and trunk/neck)
mucosal biopsy: villous atrophy, blunting of villi duodenum findings with celiac sprue
crypt abscess ulcerative colitis
complications ulcerative colitis toxic megacolon, performation, cancer
treatment ulcerative colitis aminosalicylate, cortiocsteroids, immunosupperives, tnf
COLECTOMY IS CURATIVE
most common cause lower GI bleed >50 y/o diverticulitis
acute painless large volume maroon or bright red blood in pt >50y/o diverticulosis
treatment diverticulitis often self resolving, elderly give metronidazole and cipro x 10-14 days
if multiple attacks consider surgical consult
DRE: exquisite tenderness posterior midline position; anal skin tag anal fissure
dilation of vascular bed above dentate line internal hemorrhoids
dilation of vascular bed below dentate line external hemorrhoids
intermittent dysphagia for solids and liquids, especially cold diffuse esophageal spasm; treat with PPI
dysphagia to solids first, liquids later esophageal cancer
affects the lower 2/3 of the esophagus adenocarcinoma
foul smelling breath with oral regurgitation and coughing during meals, aspiration pneumonia zenker diverticulum; tx surgical repair and myotomy
bloating, cramping, abdominal discomfort, diarrhea after gastrectomy dumping syndrome
early: overdistention from excess carbslate: hypoglycemia
sudden skin flushing, wheezing, diarrhea, plaque like fibrinous deposits on the heart carcinoid syndrome; treat with octeotride
recurrent crampy abdominal pain 3 day/month for the past 3 months associated with improvement with defecation, change in frequency or form of stool. IBS
what GI problem has high association with Hashimoto thyroiditis celiac disease