Term
| what is another name for niacin deficiency? What characterizes it? |
|
Definition
pellagra
the 3 d's: diarrhea, dermatitis, dementia |
|
|
Term
| What would the hydrogen breath test show in a lactose intolerant patient? |
|
Definition
| elevated hydrogen- colonic flora digests the unabsorbed lactose. |
|
|
Term
| Describe the probable AST/ALT ratio of a pt with alcoholic liver disease |
|
Definition
|
|
Term
| What diameter is considered positive for a PPD in a regular healthy patient with no risk factors for TB? a patient that is infected with HIV? |
|
Definition
|
|
Term
| What dz is described by an olive shaped mass felt in the RUQ at the lateral edge of the rectus abdominis muscle |
|
Definition
|
|
Term
| Describe the vomited material in a child with pyloric stenosis |
|
Definition
| Non-bilious because the obstruction takes place proximal to the duodenum |
|
|
Term
| What is felt on abdominal exam in a baby with pyloric stenosis? |
|
Definition
-olive shaped mass in the RUQ and lateral to the rectus abdominis
-peristalsis of ten abd may be even just after feeding before vomiting |
|
|
Term
| What may be seen on barium swallow in an infant with pyloric stenosis? |
|
Definition
The string sign
*US is the#1 study though |
|
|
Term
| In an infant with pyloric stenosis what are the common metabolic lab findings? |
|
Definition
Hypochloremic hypokalemic metabolic alkalosis with increased BUN
-repetitive vomiting of purely gastric materials results in loss of HCl and kidneys then start retaining hydrogen in favor of potassium
- BUN increases with dehydration |
|
|
Term
| In an infant with pyloric stenosis who is a poor surgical candidate, what is a non surgical option for tx that has been riven effective? |
|
Definition
| Atropine sulfate (the trial used it for 21 days) |
|
|
Term
| What is the clinical lab test of choice to diagnose lactose intolerance? |
|
Definition
| Lactose hydrogen breath test |
|
|
Term
| name some sources of vitamin A |
|
Definition
| liver, fish oils, fortified milk, orange pigmented veggies, and eggs |
|
|
Term
| name some functions of vitamin A |
|
Definition
| vision, epithelial cell maturity, resistance to infection, anti-oxidant |
|
|
Term
| who is at risk for a vitamin A deficiency? |
|
Definition
| elderly, alcoholics, liver disease |
|
|
Term
| what are the characteristics of a vitamin A deficiency |
|
Definition
| night blindness and dry skin |
|
|
Term
| what are some characteristics of vitamin A toxicity |
|
Definition
| skin disorders, hair loss, teratogenicity |
|
|
Term
| what is the best source of vitamin D |
|
Definition
|
|
Term
| what are the functions of vitamin D |
|
Definition
| calcium regulation and cell differentiation |
|
|
Term
| who is at risk of a vitamin D deficiency? |
|
Definition
| eldery, shut ins with low amounts of sunlight |
|
|
Term
| what are some characteristics of vitamin D deficiency? |
|
Definition
|
|
Term
| what are some characteristics of vitamin D toxicity |
|
Definition
| hypercalcemia, kidney stones, soft tissue deposits |
|
|
Term
| what are some sources of vitamin K |
|
Definition
| liver, green leafy vegetables, broccoli, peas, green beans |
|
|
Term
| what is the function of vitamin K |
|
Definition
|
|
Term
| what is the manifestation of a vitamin K deficiency |
|
Definition
|
|
Term
| what are the characteristics of vitamin K toxicity |
|
Definition
|
|
Term
| What are some sources of thiamin |
|
Definition
| pork, grains, dried beans, peas, brewer's yeast |
|
|
Term
| what are the functions of thiamin |
|
Definition
| carb metabolism and nerve function |
|
|
Term
| who is at risk of a thiamin deficiency |
|
Definition
|
|
Term
| what is the name of the disorder associated with thiamin deficiency? what are the manifestations? |
|
Definition
| Beriberi (nervous tingling, poor coordination, edema, weakness, cardiac dysfunction) |
|
|
Term
| what are some sources of riboflavin? |
|
Definition
| milk, spinach, liver, grains |
|
|
Term
| what is the function of riboflavin? |
|
Definition
|
|
Term
| what are some manifestations of a riboflavin deficiency? |
|
Definition
| oral inflammation (cheilosis and glossitis), eye disorders |
|
|
Term
| What are some sources of niacin? |
|
Definition
| bran, tuna, salmon, chicken, beef, liver, peanuts, grains |
|
|
Term
| what are the functions of niacin? |
|
Definition
| energy and fat metabolism |
|
|
Term
| who is at risk for a niacin deficiency? |
|
Definition
|
|
Term
| what is the name for the disease associated with a niacin deficiency? |
|
Definition
| pellagra (dermatitis, diarrhea, dementia, death) |
|
|
Term
| What is a side effect of taking a niacin supplement? |
|
Definition
|
|
Term
| what are some sources of vitamin C |
|
Definition
| citrus fruits, strawberries, broccoli, greens |
|
|
Term
| what are the functions of vitamin C |
|
Definition
| collagen synthesis, hormone function, neurotransmitter synthesis |
|
|
Term
| who is at risk for a vitamin C deficiency? |
|
Definition
| alcoholics and elderly men |
|
|
Term
| what is the name of the disease associated with a vitamin C deficiency |
|
Definition
| scurvy (poor wound healing, petechia, bleeding gums) |
|
|
Term
| what is a characteristic of vitamin C toxicity |
|
Definition
|
|
Term
| What is cholecystitis? what are the two types? |
|
Definition
inflammation of the gallbladder often due to obstruction of the cystic duct.
-acalculous (10%) and calculous (90%) |
|
|
Term
| Name some causes of acalculous chilecystitis |
|
Definition
| acute illness, fasting, vasculitis, CA, debilitation, major surg, severe trauma, long term TPN |
|
|
Term
| What are the main sx of cholecystitis-- where is the referred pain? is jaundice involved? is anything felt on palpation? |
|
Definition
colicky abd pain that may be epigastric at first and then moves to the RUQ. may be colicky at first and then becomes steady.
-may have referred pain to the R shoulder/scapular region
-jaundice (15%)
-palpable GB or RUQ fullness(30-40%)
-Murphys sign |
|
|
Term
| What is Murphys sign and what disease state is it associated with? |
|
Definition
it is positive when pt experiences pain with deep inspiration or cough during palpation of RUQ
CHOLECYSTITIS |
|
|
Term
| What is the initial imaging of choice to dx cholecystits? what is preferred after that? what are the secondary imaging studies? |
|
Definition
|
|
Term
| What are the results of LFTs and amylase and lipase in dx a cholecystitis patient |
|
Definition
-LFTs are ordered to rule out hepatitis but may be elevated in cholecystitis or CBD obstruction
-Amylase and lipase are ordered to r/o pancreatitis, but amylase may be slightly elevated with acute cholecystitis |
|
|
Term
| What are the most common Risk factors of acute cholecystitis |
|
Definition
-Female, fat, forty, fertile
-drugs (esp hormonal therapy in women)
-pregnancy
-rapid weight loss |
|
|
Term
| what is the most common surgery performed by general surgeons in the US |
|
Definition
|
|
Term
| What are the requirements for a pt to receive outpatient conservative tx for cholecystitis |
|
Definition
-afebrile with stable vital signs
-no evidence of obstruction by lab values
-no evidence of CBD obstruction on US
-no underlying med probs, advanced age, pregnancy, IC
-adequate analgesia
-reliable pt with transportation
-prompt follow up |
|
|
Term
| What is the conservative outpatient tx for uncomplicated cholecystitis |
|
Definition
-ABX: levaquin and flagyl
-antiemetics: phenergan
-Analgesics: oxy/APAP (percocet) OR hydro/APAP (vicodin) |
|
|
Term
| If a cholecystitis pts needs surgery but is not a surgical candidate, what is the next best option> |
|
Definition
| US guided percutaneous transhepatic cholecystostomy drainage tube coupled with abx for definitive tx |
|
|
Term
|
Definition
| an infection ascending in a bile duct that also has an obstruction |
|
|
Term
| what are the two main causes of cholangitis |
|
Definition
| biliary tract manipulation and common bile duct stones |
|
|
Term
| What is the usual presentation of a cholangitis patient |
|
Definition
-HX of choledocholithiasis or recent biliary tract manipulation with:
Charcot's triad or Reynolds pentad
-PE shows fever, icterus, jaundice, abd pain |
|
|
Term
| What is charcots triad and reynolds pentad and what disease state are they associated with |
|
Definition
CT: jaundice, fever, and RUQ tenderness
RP: CT + altered mental status and hypotension (indicates sepsis) |
|
|
Term
| What is the main work up for cholangitis |
|
Definition
CBC: leukocytosis
CMP: hyperbilirubinema and increased alkaline phosphatase
blood cultures: positive in 50% of patients |
|
|
Term
| What is the number one radiological study for dx of cholangitis |
|
Definition
|
|
Term
| What is the initial tx of cholangitis |
|
Definition
| broad spectrum IV abx and electrolyte and fluid replacement |
|
|
Term
| If surgical techniques are necessary for a cholangitis patient, what procedure is often performed over surgery |
|
Definition
| endoscopic biliary drainage and decompression |
|
|
Term
| What is a gall bladder disease state that is caused by IBD (generally ulcerative colitis) 80% of the time |
|
Definition
| PSC (primary sclerosing cholangitis) |
|
|
Term
| What are two complications of cholangitis |
|
Definition
| pyogenic liver abscess and acute renal failure |
|
|
Term
| what does choledocholithiasis mean |
|
Definition
| presence of gall stones in the common bile duct |
|
|
Term
| describe chronic cholecysitis |
|
Definition
| chronically having gallstones in the GB that cause progressive fibrosis and loss of function of the GB and can predispose to GB cancer |
|
|
Term
| what are the two main substances found in gallstones |
|
Definition
| cholesterol and calcium bilirubinate |
|
|
Term
| what is a gallstone dissoluting agent |
|
Definition
| ursodeoxycholic acid (ursodiol) |
|
|
Term
| do asymptomatic gallstones require tx? |
|
Definition
| not usually, see notes for exceptions |
|
|
Term
| What is the source of alkaline phosphatase site, when do you expect it to be elevated |
|
Definition
| Bile duct epithelium, will be elevated in bile duct obstruction |
|
|
Term
| What is entero hepatic circulation |
|
Definition
| Circulation of bile acids from the liver to gut back to the liver |
|
|
Term
| What is the source of cck |
|
Definition
|
|
Term
| At what level of serum total bilirubin does one begin to get jaundiced |
|
Definition
|
|
Term
| Give 6 signs and symptoms of obstructive jaundice |
|
Definition
Jaundice
Dark urine
Clay colored stools (acholic stools)
Pruritius
Loss of appetite
Nausea |
|
|
Term
| What causes itching in obstructive jaundice |
|
Definition
| Bile salts in the dermis (not bilirubin!) |
|
|
Term
| What is the initial diagnostic study of choice for evaluation of the biliary tract/gallbladder/cholelithiasis |
|
Definition
|
|
Term
| What is the initial study of choice for obstructive jaundice |
|
Definition
|
|
Term
| What lab results are associated with obstructive jaundice |
|
Definition
| Elevated alkaline phosphatase, elevated bilirubin with or without LFTs |
|
|
Term
| Is hypercholesterolemia a risk for gallstone formation? |
|
Definition
|
|
Term
|
Definition
| Referred right sub scapular pain of biliary colic |
|
|
Term
| What is the major feared complication of ERCP |
|
Definition
|
|
Term
| What is the major risk factor for sclerosing cholangitis, in particular what type of this disease |
|
Definition
| Inflammatory Bowel disease, ulcerative colitis |
|
|
Term
| What is sclerosing cholangitis |
|
Definition
| Multiple inflammatory fibrous thickening s of bile duct walls resulting in biliary strictures |
|
|
Term
|
Definition
| Small bowel obstruction from a large gallstone (>2.5 cm) that has eroded through the gallbladder and into the duodenum/small bowel |
|
|
Term
|
Definition
| Tumor that involves the junction of the right and left heretic ducts |
|
|
Term
| What is the most common abdominal surgical emergency |
|
Definition
|
|
Term
| Name some signs and sx of appendicitis |
|
Definition
Abd pain that migrates to the RLQ
Anorexia, n/v
Pain in testes
Diarrhea (18%)
Rebound tenderness, guarding, diminished bowel sounds |
|
|
Term
| Where is McBurney's point |
|
Definition
| RLQ, point one third from the anterior superior iliac spine to the umbilicus in a patient with appendicitis |
|
|
Term
|
Definition
| Deep palpating of the LLQ causes referred pain in RLQ in a pt with appendicitis |
|
|
Term
|
Definition
| RLQ pain when right thigh is extended or flexed against resistance as patient lies on left Side in a pt with appendicitis |
|
|
Term
|
Definition
| Pain in the RLQ when flexed right thigh is internally and externally rotated with patient supine in a pt with appendicitis |
|
|
Term
|
Definition
| Pain with cough in a pt with appendicitis |
|
|
Term
| What is the MCC of appendicitis |
|
Definition
|
|
Term
| What is a major DDx for a pt with appendicitis who is a female of child bearing age |
|
Definition
|
|
Term
| What's the radiographic study of choice in a patient with suspected appendicitis |
|
Definition
|
|
Term
| What's a good opioid for the tx pain due to appendicitis? |
|
Definition
| Demerol (meperidine) bc it reduces pressure in the gut so it is good for abdominal pain |
|
|
Term
| What is the average length of a healthy appendix |
|
Definition
|
|
Term
| In the later stages of pregnancy what might appendicitis present as |
|
Definition
|
|
Term
| What is the MANTRELS mnemonic used for and what are the components of it |
|
Definition
Appendicitis
migration to the RLQ
Anorexia
N or v
Tenderness in the RLQ (2 pt's)
Rebound pain
Elevated temp
Leukocytosis (2 pt's)
Left shift |
|
|
Term
| Can you have an abnormal urlinalysis with appendicitis |
|
Definition
| Yes; mild hematuria and pyuria are common in appendicitis with pelvic inflammation resulting in inflammation of the ureter |
|
|
Term
| Does a positive urinalysis rule out appendicitis |
|
Definition
| No; ureteral inflammation resulting from the periappendiceal inflammation can cause abnormal urinalysis |
|
|
Term
| How long after removal of a NONruptured appendix should antibiotics continue post-op |
|
Definition
|
|
Term
| How long do you give antibiotics for perforated appendicitis |
|
Definition
| Until the patient has a normal WBC count and is afebrile, ambulating, and eating a regular diet (usually 3-7 days) |
|
|
Term
| What is the most common general surgical emergency in pregnancy |
|
Definition
|
|
Term
|
Definition
| Pelvic pain caused by ovulation |
|
|
Term
| do asymptomatic gallstones require tx? |
|
Definition
| not usually, see notes for exceptions |
|
|
Term
|
Definition
| A process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction |
|
|
Term
| What is the triad of sx characteristic to intussusception |
|
Definition
| -vomiting, abd pain, and passage of blood per rectum |
|
|
Term
|
Definition
| Sausage shaped mass in the right hypochondrium and emptiness in the RLQ |
|
|
Term
| When is the mass in intussusception best palpated |
|
Definition
| Between spasms of colic when the infants quiet |
|
|
Term
| What is the traditional and most reliable way to make the dx of intussusception in kids |
|
Definition
|
|
Term
| What are the two characteristic signs of intussusception found in ultra Sound. Is ultra sound the study of choice for intussusception |
|
Definition
-target sign and pseudo kidney signs
-no, contrast enema is |
|
|
Term
| What is the most common type of non op reduction used in intussusception |
|
Definition
| Pneumatic with air insufflation |
|
|
Term
| What are the two terms used to describe the intestine in intussusception |
|
Definition
-intussusceptum: invaginating portion of the intestine
-intusssuscipiens: the receiving portion of the intestine |
|
|
Term
| How is intussusception dx and tx in adults |
|
Definition
|
|
Term
| What is another name for toxic megacolon |
|
Definition
|
|
Term
|
Definition
| An acute toxic colitis with dilatation (either total or segmental) of the Colon |
|
|
Term
| What is a RF for toxic megacolon in an infant |
|
Definition
|
|
Term
| What are some risk factors for toxic megacolon in adults |
|
Definition
| UC, crohns colitis, pseudomembranous colitis, infectious colitides |
|
|
Term
| Name some s/ sx of toxic megacolon |
|
Definition
Fever, rectal bleeding, tenesmus, vomiting, abd distention, severe bloody diarrhea, vomiting, dehydration
Rigid abdomen, localized, diffuse or rebound abd tenderness |
|
|
Term
| What are the two hallmarks of toxic megacolon |
|
Definition
| Non obstructive colonic dilatation >6 cm and signs of systemic toxicity |
|
|
Term
| What are the diagnostic criteria for toxic megacolon |
|
Definition
1. Radiographic evidence of colonic dilatation
2. Any 3 of the following: fever, tachycardia, leukocytosis, or anemia
3. Any 1 of the following: dehydration, altered mental status, electrolyte abnormality, hypotension |
|
|
Term
| Keeping in mind predisposing factors for toxic megacolon, what may make the symptoms and physical findings be minimal |
|
Definition
| Inflammatory colitides which often cause this problem are often treated by high dose steroids which can mask the s/sx |
|
|
Term
| Describe the form of toxic megacolon most commonly associated with ulcerative colitis |
|
Definition
| Transverse colon dilated greater than 6 cm with loss of haustration |
|
|
Term
| What are the three main treatment goals of toxic megacolon |
|
Definition
-reduce colonic distention to prevent perforation
-correct fluid and electrolyte disturbances
-tx toxemia and precipitating factors |
|
|
Term
| Describe the different between the abd pain of appendicitis and the abd pain of gastroenteritis |
|
Definition
| In appendicitis the pain precedes vomiting, then migrates to the RLQ where it intensifies from local peritoneal irritation |
|
|
Term
| What patient behavior should make you seriously question the diagnosis of appendicitis |
|
Definition
| If the patient is hungry and wants to eat. |
|
|
Term
| What is the most common bacterial cause of mew enteric lymphadenitis that can lead to appendicitis |
|
Definition
|
|
Term
| What is the most common cause of small bowel obstruction in toddlers (<2yrs old) |
|
Definition
|
|
Term
| What is the most common site of intussusception |
|
Definition
| Terminal ileum involving the ileocecal valve and extending into the ascending colon |
|
|
Term
| What are the top four causes of SBO |
|
Definition
1. Post op adhesions
2. Malignancy
3. Crohn's disease
4. Hernias |
|
|
Term
| Describe the bowel Segments proximal to a SBO |
|
Definition
| Proximal to the SBO is dilated |
|
|
Term
| Describe the main difference in orientation between a proximal and distal SBO |
|
Definition
Proximal will have abd pain that has occurred for a shorter period of time that is colicky and accompanied by bilious vomiting
Distal pain is lasting as long as several days, progressive in nature, and accompanied by abd distention |
|
|
Term
|
Definition
| Nausea, vomiting (more proximal SBO), diarrhea (early finding), constipation (late finding), fever/tachycardia (late finding and may be seen with strangulation) |
|
|
Term
| Describe the bowel sounds heard in a SBO |
|
Definition
| Hyperactive early and hypo active later |
|
|
Term
| What the radiological study of choice for SBO , what will you see |
|
Definition
| X-ray of abd/pelvis two views supine and upright. Dilated small bowel loops with air fluid levels, absent or minimal colonic gas |
|
|
Term
| What are the top five steps in the ED for the care of an SBO |
|
Definition
Aggressive fluid resuscitation
Bowel decompression by NG tube
PRN analgesia and antiemetics
Surgical consult
Abx |
|
|
Term
| In a SBO that is simple or partial (NOT strangulated) what should be done for up to three days as tx |
|
Definition
| Non op trial of NG tube decompression and most will resolve themselves |
|
|
Term
| What type of SBO is a surgical emergency |
|
Definition
|
|
Term
| What are the two MCC of LBO |
|
Definition
Colon cancer (60%)
Diverticulitis (20%) |
|
|
Term
| What drug is associated with acute mesenteric ischemia |
|
Definition
|
|
Term
| T which intestinal artery do emboli preferentially go to in acute mesenteric ischemia |
|
Definition
|
|
Term
| What is the classic triad of acute mesenteric ischemia |
|
Definition
1. Acute onset of pain
2. Vomiting, diarrhea, or both
3. Hx of a fib, heart disease, or both |
|
|
Term
| What is the gold standard diagnostic test for acute mesenteric ischemia |
|
Definition
|
|
Term
| What are the symptoms of acute mesenteric ischemia |
|
Definition
| Severe pain, out of proportion to the exam, vomiting/diarrhea/hyper defecation, maybe heme stools |
|
|
Term
| What are the symptoms of chronic mesenteric ischemia |
|
Definition
| Weight loss, post paranoiac abdominal pain, anxiety/fear of food due to the pain, could have NVD, could have heme positive stools |
|
|
Term
| What vasodilatory drug is used in non occlusive mesenteric ischemia papaverine |
|
Definition
|
|
Term
| What action taken by a patient with chronic mesenteric ischemia can help with the severe pain |
|
Definition
|
|
Term
| What three vessels supply blood to the gut |
|
Definition
|
|
Term
| What gene is involved in hereditary familial polyposis syndrome |
|
Definition
|
|
Term
| High intake of what two things can be protective against polyp formation |
|
Definition
|
|
Term
| What are the screening guidelines for colonoscopy as far as when to begin, when to being if first degree family hx, and when to rescreen after polyp removal |
|
Definition
50
5 years before diagnosis of relative
Every 3 or 5 years depending on the polyp, whether its low risk or high risk respectively |
|
|
Term
| What are the two anatomic classifications of polyps |
|
Definition
Sessile (flat)
Pedunculated (on a stalk) |
|
|
Term
| What are the 4 histologic classifications of polyps |
|
Definition
-inflammatory pseudopolyp (as seen in UC or crohns)
-hamartamotus (NL tissue in abnormal configuration)
-hyperplastic (benign, NL cells, no malignant potential)
-neoplastic (proliferation of undifferentiated cells, pre or pre malignant |
|
|
Term
| What are the three subtypes of neoplastic polyps |
|
Definition
Tubular adenoma, tubulovillious adenomas, villous adenomas
Villous>tubulovillious > tubular |
|
|
Term
| What region of the colon are most polyps found in |
|
Definition
|
|
Term
|
Definition
| A painful linear tear or crack in the distal anal canal which , in the short term, usually involves only the epithelium and in the long term involves full thickness of the anal mucosa |
|
|
Term
| On what part of the anus does an anal fissure usually occur? What does different placement suggest? |
|
Definition
Anterior or posterior canal midline
Off midline: crohns, aids, std (syphilis) or cancer |
|
|
Term
| What are some mainstays of treatment for anal fissures |
|
Definition
| Bulking agents (Metamucil), increased fluids, site baths, and nitroglycerin if the first three provide no relief |
|
|
Term
| What is the usual cause and pathophysiology of an anorectal abscess |
|
Definition
| Obstruction of anal glands with obstructing debris leading to infection and eventual abscess formation |
|
|
Term
| What are the mainstays of treatment for an anorectal abscess |
|
Definition
| Surgical drainage (I and D) followed by WASH : warm water cleansing, analgesics, stool softeners, and high fiber diet |
|
|
Term
| Give some causes of hemorrhoids |
|
Definition
| Prolonged erect posture, constipation, pregnancy, diarrhea, obesity, fam hx, portal HTN, ascites, anatomic abnormalities |
|
|
Term
| What are the two types of hemorrhoids |
|
Definition
|
|
Term
| What are the four stages of external hemorrhoids |
|
Definition
Stage 1: bleed with defacation
2: protrude from anal opening but reduce spontaneously
3: requires manual reduction after bowel movements. Pain and discomfort
4: chronically protruding and risk of strangulation |
|
|
Term
| What is the treatment for hemorrhoids.. Stage 1 and 2, stage 3, and stage 4 |
|
Definition
1&2: high fiber diet, increased fluids, and bulk laxatives
3: suppositories with anesthetic and astringent
4 or unresponsive: surgery injection , rubber band ligation, or sclerotherapy |
|
|
Term
| What are some signs and symptoms of hemorrhoids |
|
Definition
| Pruritus ani, rectal bleeding/pain, fullness or mass sensation |
|
|
Term
| What types of HPV are known causes of rectal warts and neoplasms |
|
Definition
Warts 6 and 11
Neoplasms 16 and 18 |
|
|
Term
| What are some treatment options for anal warts |
|
Definition
| Imiquimod (Aldara), cryotherapy, laser treatment, electrodessication, surgical destruction/excision |
|
|
Term
| What are the too three sites of metastasis from a colorectal cancer |
|
Definition
|
|
Term
| Name some medications, other ingested items, that can cause esophagitis by relaxing smooth muscle |
|
Definition
-nitrates, CCBs, caffeine, albuterol, aminophylline
-SMOKING |
|
|
Term
| What are 3 classic symptoms of esophagitis? |
|
Definition
-heartburn
-acid regurgitation (water brash or pyrosis)
-dysphagia or odynophagia |
|
|
Term
| Obstruction of liquids during swallowing is a red flag for a DO other than esophagitis, name a few |
|
Definition
-neuromuscular DO
-neoplasm
-esophageal diverticulum |
|
|
Term
| What is the most common fungal cause and the most common viral cause of esophagitis in an IC pt |
|
Definition
|
|
Term
| on upper endoscopy, what will be seen for a patient with esophagitis due to CMV or HIV, HSV, or Candida |
|
Definition
CMV or HIV: deep, large ulcers
HSV: shallow multiple ulcers
Candida: white plaques |
|
|
Term
| What is a type of esophagitis seen in pts with food allergies? Tx? |
|
Definition
eosinophilic
fluticasone via metered dose inhaler |
|
|
Term
| You see a birds beak appearance on a CXR, you think |
|
Definition
|
|
Term
| you see a corkscrew appearance of the esophagus on the CXR, you think... |
|
Definition
|
|
Term
| What is neurogenic dysphagia? |
|
Definition
| causes difficulty swallowing with both liquids and solids. Caused by injury or dz of the brain stem of cranial nerves involved in swallowing |
|
|
Term
| what is zenker's diverticulum? |
|
Definition
| out pouching of posterior hypo pharynx that can cause regurgitation of undigested food/liquids into the pharynx several hrs after eating |
|
|
Term
| What is achalasia? how does it look on a CXR? |
|
Definition
| -global esophageal motor disorder in which peristalsis is decreased an LES tone increased. Causing slowly progressive dysphagia with episodic regurgitation and chest pain |
|
|
Term
| How does scleroderma sometimes manifest in the esophagus? |
|
Definition
| causes decreased esophageal sphincter tone and peristalsis- predisposing the pt to the symptoms and complications of reflux esophagitis |
|
|
Term
| a pt presents after a night of heaving drinking with hematemesis... you immediately think? |
|
Definition
|
|
Term
| What exactly is a mallory weis tear? |
|
Definition
| a linear mucosal tear in the esophagus, usually at the GE junction |
|
|
Term
| SCC of the esophagus is (more/less) common in the US than adenocarcinoma of the esophagus? In which part of the esophagus does each occur? What are the predisposing factors for each? |
|
Definition
-more
-SCC: prox 2/3; AdenoCA: distal 1/3
-SCC: smoking, alcohol; AdenoCA: barrett's, GERD, scleroderma, zollinger ellison, hiatal hernia |
|
|
Term
| What are some s/sx of an esophageal neoplasm? |
|
Definition
progressive dysphagia/odynophagia
unintentional weight loss
vomiting |
|
|
Term
| What is the most common cause of esophageal stricture? the second and third? |
|
Definition
GERD (70-80%)
post op strictures (10%)
corrosive strictures (<5%) |
|
|
Term
| Name some common s/sx of esophageal stricture? |
|
Definition
| dysphagia, odynophagia, unintentional weight loss, regurgitation of food, food impaction, chest pain, heart burn |
|
|
Term
| What are the two best treatments for esophageal stricture> |
|
Definition
esophageal dilatation
PPIs |
|
|
Term
| There are three disease processes that cause strictures. name each and give a short description |
|
Definition
-intrinsic: inflammation, fibrosis, neoplasia
-extrinsic: lymph node enlargement or direct invasion
-dz's that disrupt esophageal peristalsis a/o LES function by effects on smooth muscle and its innervation |
|
|
Term
| What causes esophageal varices? Which is usually caused by .... |
|
Definition
| Portal HTN, usually caused by cirrhosis (alcoholism) or long standing hepatitis |
|
|
Term
| What part of the esophagus do esophageal varices usually occur? |
|
Definition
|
|
Term
| Esophageal varices are usually asymptomatic until a life threatening bleed occurs. What are some s/sx that can occur before a life threatening bleed? |
|
Definition
| weakness, malaise, anorexia, abd pain, pallor, jaundice, ascites, splenomegaly |
|
|
Term
| what syndrome can cause thrombosis of portal vein and is on the DDX for esophageal varices? |
|
Definition
| budd chiari syndrome: triad of abd pain, ascites, and hepatomegaly |
|
|
Term
| what is the tx for a bleeding esophageal varice? |
|
Definition
EVL
high vol fluid replacement
pharmacologic vasoconstriction (octreotide) and BB |
|
|
Term
| how does octreotide work in the tx of esophageal varices? What is another option |
|
Definition
causes splanchnic vasoconstriction and reduces portal pressures.
vasopressin is second line due to cardiac side effects |
|
|
Term
| What is the tx for nonbleeding esophageal varices? |
|
Definition
|
|
Term
| What are the three major pathophysiologic causes of GERD |
|
Definition
1. dysfunction of the LES allowing reflux of gastric contents
2. Poor esophageal motility decreases clearance of acidic material
3. Delayed gastric emptying causes increased intragastric pressure resulting in increased pressure against the LES--- overcoming LES pressure and leasing to reflux |
|
|
Term
| Name some major risk factors for GERD |
|
Definition
-drug induced (nitrates, bronchodilators, CCBs)
-caffeine, smoking,
-Pregnancy
-Obesity
-Scleroderma |
|
|
Term
| What are pharmacologic treatments for GERD |
|
Definition
| H2 antagonists and PPIs, Both decrease gastric acid secretion in different ways |
|
|
Term
|
Definition
Ranitidine- Zantac
Cimetidine- tagamet
famotidine- pepcid
nizatidine- axid |
|
|
Term
|
Definition
omeprazole- prilosec
pantropazole- protonix
esomeprazole- nexium
lansoprazole- prevacid |
|
|
Term
| What is the MCC of chronic gastritis? |
|
Definition
|
|
Term
| WHat are some s/sx of gastritis? |
|
Definition
| epigastric burning, early satiety, N/V, belching, halitosis, black tarry stool, vomiting coffee ground material |
|
|
Term
| what are some causes of gastritis other than H. pylori |
|
Definition
| regular use of NSAIDs, excess etoh, excess smoking, severe stress, |
|
|
Term
| what is the best test for evaluation of Upper GI pain? |
|
Definition
|
|
Term
| What is first line tx for mild-mod gastritis with no concerning sx? |
|
Definition
| H2 blocker or PPI and stop NSAIDs |
|
|
Term
| What is the triple therapy for h pylori? quadruple? |
|
Definition
-Triple (use when low clarithromycin resistance)
1. PPI 2. Amoxicillin (sub Flagyl if pcn allergic) 3. Clarithromycin
-Quad therapy (when clarithromycin resistance high)
1. PP1 2. Bismuth 3. Flagyl 4. Tetracycline |
|
|
Term
| why do NSAIDs cause gastritis? |
|
Definition
| NSAIDs are cox inhibitors. COX is the rate limiting enzyme in prostaglandin formation. PGs protect the mucosal lining of the stomach from acid. NSAIDs inhibit cox, decrease PGs and lead to mucosal injury |
|
|
Term
| why do NSAIDs cause gastritis? |
|
Definition
| NSAIDs are cox inhibitors. COX is the rate limiting enzyme in prostaglandin formation. PGs protect the mucosal lining of the stomach from acid. NSAIDs inhibit cox, decrease PGs and lead to mucosal injury |
|
|
Term
| What is the MCC type of gastric neoplasm seen? where is it most prevalent |
|
Definition
| adenocarcinoma. not common at all in the US, huge problem in Japan |
|
|
Term
| Name some RF's for adenocarcinoma of the stomach |
|
Definition
-h pylori
-chronic atrophic gastritis
-tobacco abuse
-FAP
-NPHCC
-pernicious anemia
-eating lots of high preservative foods |
|
|
Term
| What are three areas of lymph nodes that gastric adenocarcinoma commmonly metastasizes to? |
|
Definition
-sister mary joseph's node: umbilicus
-Virchows: left supraclavicular
-Irish's: left axillary |
|
|
Term
| What is Zollinger Ellison syndrome? What hereditary issue is it related to? Where are they often found? What is the dx lab? |
|
Definition
gastrin secreting tumor (gastrinoma) that results in PUD
MEN 1
pancreas and duodenum
Fasting gastrin level >150 |
|
|
Term
| What is the most common extra nodal site for a non-hodgkin lymphoma |
|
Definition
|
|
Term
| What is the most common cause of peptic ulcer disease (PUD)? what is another very common cause? |
|
Definition
|
|
Term
| Give the sx of a duodenal ulcer, the sx of a gastric ulcer, and the shared symtpoms |
|
Definition
-Duodenal: relieved with food and antacids, worse at night
-Gastric: aggravated by food, more constitutional sx (anorexia, weight loss, NV)
-Both: burning, gnawing mid epigastric pain; may radiate to the back; dyspepsia (belching, bloating, distention, heart burn) |
|
|
Term
| If a patient with PUD does not have a hx of NSAID use and is negative for H Pylori, what must be ruled out? How? |
|
Definition
| ZES, gastrin levels with or without secretin test |
|
|
Term
| What is the tx for PUD? If it is caused by H Pylori? |
|
Definition
-avoid triggers
-PPIs and H2 receptor antagnists
-Triple tx for HP: PPI, clarithromycin, amoxicillin |
|
|
Term
| What are some non-infectious types of hepatitis? |
|
Definition
| alcoholic, drug induced, autoimmune, and many hereditary types |
|
|
Term
| name three viruses that can cause hepatitis in mostly IC patients |
|
Definition
|
|
Term
| What types of hepatitis are spread via the fecal oral route? |
|
Definition
|
|
Term
| Hepatitis D can only be transmitted with Hepatitis ___ |
|
Definition
|
|
Term
|
Definition
| parenterally or sexually. also perinatal |
|
|
Term
|
Definition
parenteral
sexual and perinatal are not common |
|
|
Term
| What types of Hepatitis can progress to chronic disease? |
|
Definition
|
|
Term
| Some chronic Hep patients are asymptomatic (carriers) and only present with the late complications. name the two end stage complications of Hep |
|
Definition
cirrhosis
hepatocellular carcinoma (HCC) |
|
|
Term
| Which type of Hep has a greater chance of progressing from acute to chronic, B or D? Which has a greater risk of developing cirrhosis or HCC? |
|
Definition
-C (>80%), B is only 10-15%
-B (25-40%), C is only 10-25% |
|
|
Term
| What are some s/sx of viral hepatitis? |
|
Definition
-s: jaundice, tea colored urine, tender hepatomegaly
-sx: malaise, anorexia, low grade fever, vague abd discomfort, NVD |
|
|
Term
| What lab shows active HAV? |
|
Definition
| immunoglobulin M AB to HAV |
|
|
Term
|
Definition
| supportive, be careful not to spread, avoid ETOH and other toxins |
|
|
Term
For Hep B, what do the following markers tell:
-HBsAg
-anti HBc
-anti HBs
-HBeAg |
|
Definition
-HbsAg: ongoing infection
-anti HBc: acute hepatitis
-anti HBs: immunity by past infection or vaccine
-HBeAg: highly contagious active infection |
|
|
Term
| What does the presence of the Hep C antibody mean? |
|
Definition
|
|
Term
| What two types of Hep are commonly co-infections with HIV? |
|
Definition
|
|
Term
| where is Hep E prevalent? |
|
Definition
| india, pakistan, SE Asia, parts of Africa |
|
|
Term
| What is the MCC of cirrhosis? 2nd MCCs? |
|
Definition
-Alcoholic liver dz
-Hep B and Hep C |
|
|
Term
| What is the pathophysiology of cirrhosis... specifically what two major events are caused by this distortion of liver anatomy? |
|
Definition
-decreased blood flow through the liver with subsequent HTN in portal circulation causes widespread manifestations: ascites, peripheral edema, splenomegaly, and varices (esophageal, gastric, hemorrhoids, caput medusae)
-hepatocellular failure leads to impairment of biochemical functions such as: decr. albumin synthesis and decr. clotting factor synthesis |
|
|
Term
| What is Child's Classification? Give the classes |
|
Definition
-estimates hepatic reserve in liver failur
-class A is mild dz
-Class C is most severe dz |
|
|
Term
| What is the gold standard for dx of cirrhosis? |
|
Definition
|
|
Term
| What are the classic signs of chronic liver disease? |
|
Definition
| -ascites, varices, gynecomastia, testicular atrophy, palmar erythema, spider angiomas, hemorrhoids, caput medusae |
|
|
Term
| What is the tx of cirrhosis? |
|
Definition
-abstinence from ETOH (regardless of underlying cause)
-interferons for Hep B and C if they're they cause
-liver transplant (must be ETOH free for 6 months) |
|
|
Term
| What is the mnemonic to remember the complications of cirrhosis? What does it stand for? |
|
Definition
-AC 9H
-ascites
-coagulopathy
-portal HTN, hypoalbuminemia, hyperammonemia, hyperestrinism, hepatic encephalopathy, hepatorenal syndrome, hyperbilirubinema/jaundice, HCC |
|
|
Term
| What is the most life threatening complication of portal HTN? |
|
Definition
|
|
Term
| What are the three locations of varices common with Portal HTN? |
|
Definition
-gastric (10%), esophageal (90%)
-rectal hemorrhoids
-caput medusae (distention of abd wall veins) |
|
|
Term
| How does ascites of the abdomen occur in portal HTN, specifically what are the pressure changes that are occurring? |
|
Definition
| -the accumulation of fluid in the peritoneal cavity occurs from an increase in hydrostatic pressure 2ary to portal HTN and then a decrease in oncotic pressure 2ary to hypoalbuminemia |
|
|
Term
| What is the method of diagnosis for ascites? |
|
Definition
| abd US can detect as little as 30 mL of fluid |
|
|
Term
| The fluid from a paracentesis of a pt with portal HTN would show what in regards to total PRO concentration and serum ascites albumin gradient? |
|
Definition
-total pro concentration <3 g/dL (transudate)
-serum ascites albumin gradient >1.1 g/dL (<1.1 g/dL is unlikely to be from portal HTN) |
|
|
Term
| What causes hepatic encephalopathy? What are some s/sx of hepatic encephalopathy |
|
Definition
-toxic metabolites (AMMONIA) usually filtered out by the liver accumulate and reach the brain
-decr. mental function, confusion, poor concentration |
|
|
Term
| What musk findings may be seen with hepatic encephalopathy |
|
Definition
-rigidity and hyperreflexia
-ASTERIXIS (flapping tremor) that can be seen with extension of the arms and dorsiflexion of the hands |
|
|
Term
| what does SBP stand for in terms of a cirrhosis pt? |
|
Definition
| -spontaneous bacterial peritonitis |
|
|
Term
| what is the MC agent of SBP |
|
Definition
|
|
Term
| what is the dx parameters for SBP? |
|
Definition
|
|
Term
| What are the signs of hyperestrinism in cirrhosis? why does hyperestrinism happen? |
|
Definition
-testicular atrophy, gynecomastia, spider angiomas, palmar erythema
-occurs d/t lack of estrogen binding PRO, so the serum estrogen levels increase |
|
|
Term
| Why is Vit K ineffective in tx coagulopathy caused by cirrhosis? What is the tx? |
|
Definition
-bc Vit K cannot be used by the failing liver
-FFP is the tx |
|
|
Term
| what percentage of pt's with cirrhosis get HCC (hepatocelllular carcinoma)? |
|
Definition
|
|
Term
| Name some s/sx of a hepatic neoplasm |
|
Definition
| -weight loss, RUQ abd pain, tender hard palpable liver mass, peritoneal friction rub, hepatic bruit |
|
|
Term
| Where are hepatic cancer most common? (areas of the world) |
|
Definition
| where hep B is endemic (SE asia and subsaharan africa) |
|
|
Term
| What serum lab value is highly specific (91%) but only 64% sensitive for liver neoplasms? |
|
Definition
| alpha fetoprotein >20 ng/mL |
|
|
Term
| What is the pathophysiology of acute pancreatitis? |
|
Definition
| -it is an inflammation of the pancreas resulting from prematurely activated pancreatic enzymes that invoke pancreatic tissue autodigestion |
|
|
Term
| What are the two main causes of pancreatitis? Name some other less common causes? MC pimping question? |
|
Definition
-ETOH abuse (40%)
-Gallstones/biliary tract dz (40%)- gallstones passing into CBD and blocking the ampulla of vater
-s/p ERCP, drug induced, post-op
-Scorpion Bites |
|
|
Term
| What is the MCC of acute pancreatitis in pediatrics |
|
Definition
|
|
Term
| Describe the s/sx of acute pancreatitis |
|
Definition
-acute epigastric abd pain, severe steady and dull, made worse with oral intake, laying supine, made better with leaning forward
-N, V, anorexia
-low grade temp, hypotensive, tachycardic
-epigastric tenderness and abd distention |
|
|
Term
| Between amylase and lipase, which is more specific for acute pancreatitis dx? Which is most commonly used? What are some criteria for out of the range of NL for the more commonly used test? |
|
Definition
-lipase more specific than amylase
-amylase MC ordered
-amylase 5x the upper limits of NL should strike suspicion |
|
|
Term
| What criteria is often used to evaluate mortality in patients with acute pancreatitis? What lab marker is not a part of this criteria that one would think would be? |
|
Definition
Ranson's Criteria
amylase is not a part of it! |
|
|
Term
| What is the best rad for dx of acute pancreatitis? |
|
Definition
|
|
Term
| What are the signs of a hemorrhagic pancreatitis? |
|
Definition
| -Cullen's (ecchymosis around the umbilicus), Grey Turner's (ecchymosis of the flanks) , and Fox's (ecchymosis along the inguinal ligament) Signs |
|
|
Term
| What is the tx of acute pancreatitis? |
|
Definition
-NPO, BOWEL REST!
-IV fluids
-Pain control, usually necessitates narcotics
-NG tube if severe NV or ileus |
|
|
Term
| At what # of positive Ranson Criteria should a patient go to the ICU for monitoring? |
|
Definition
|
|
Term
| What is the pathophysiology of chronic pancreatitis? |
|
Definition
| -persistent or continuing inflammation of the pancreas, with fibrotic tissue replacing pancreatic parenchyma, and alteration of pancreatic ducts (areas of stricture/dilation)-- eventually resulting in irreversible destruction of the pancreas |
|
|
Term
| What is the MCC of chronic pancreatitis? |
|
Definition
|
|
Term
| What are the signs and sx or chronic pancreatitis? |
|
Definition
-recurrent or persistent severe epigastric abd pain, often made worse with ETOH or eating, 50% radiate to back, worse when lying and better when leaning forward
-NV
-weight loss due to malabsorption, alcohol abuse, and DM
-steatorrhea due to malabsorption |
|
|
Term
| What is the classic triad of chronic pancreatitis? |
|
Definition
| steatorrhea, pancreatic calcifications, and DM |
|
|
Term
| What is the gold standard for diagnosis of chronic pancreatitis? |
|
Definition
|
|
Term
| Are labs helpful in determination of chronic pancreatitis? |
|
Definition
| No, amylase and lipase are usually NL or only slightly elevated |
|
|
Term
| What is the biggest social concern/complication associated with chronic pancreatitis? |
|
Definition
|
|
Term
| What are some non-op tx for chronic pancreatitis? |
|
Definition
-NPO/ BOWEL REST for acute exacerbation
-narcotics
-Pancreatic enzymes and H2 blockers
-Insulin
-Abstinence from ETOH
-frequent, small-vol, low-fat meals |
|
|
Term
| What is the goal of surg in chronic pancreatitis? |
|
Definition
| relieve incapacitating pain |
|
|
Term
| What is the most common type of pancreatic neoplasm (histologically speaking) |
|
Definition
|
|
Term
| What is the most common location of a pancreatic neoplasm? second and third MC? |
|
Definition
-head (75%)
-body (20%)
-tail (5-10%) |
|
|
Term
| What is the most clearly est. risk for pancreatic ca? what are some others? |
|
Definition
-Tobacco abuse!
-diabetes, heavy ETOH, chronic pancreatitis, increasing age |
|
|
Term
| Is painless jaundice a common sign of pancreatic cancer? |
|
Definition
|
|
Term
| What is Courvoisier's Sign? |
|
Definition
| palpable gallbladder most often due to CA of the pancreatic head |
|
|
Term
| What is the most sensitive test for dx of pancreatic neoplasm? |
|
Definition
|
|
Term
| what are two cancer markers that are measured in pancreatic tumors dx? |
|
Definition
|
|
Term
| What medications can contribute to constipation? |
|
Definition
| NARCOTICS, anticholinergics (antidepressants), iron, CCBs, aluminum or Ca antacids, Laxative abuse/dependence |
|
|
Term
| What are some endocrine/metabolic causes of constipation? |
|
Definition
| hypothyroid, hypercalcemia, hypokalemia, dehydration, uremia |
|
|
Term
| How much fiber should be recommended per day to a pt suffering from constipation? H20 intake? |
|
Definition
10-20 grams of fiber per day
64 oz or 1.5-2 L of water |
|
|
Term
| What is the cause of diverticulosis? |
|
Definition
| increased intraluminal pressure. the inner layer of the colon bulges through a focal area of weakness in colon wall (usually an area of blood vessel penetration) |
|
|
Term
| What is the cause of diverticulitis? |
|
Definition
| inflammation of one or more diverticula suspectedly due to fecal material or undigested food getting stuck in the out pouching causing obstruction, which may lead to erosion and micro perforation |
|
|
Term
| What is the most common area of the colon for diverticula? |
|
Definition
| sigmoid colon, probs d/t higher pressure in this area |
|
|
Term
| What are some known risk factors for diverticular dz? |
|
Definition
| low fiber diet (which leads to) and constipation. Causes increased intraluminal pressures |
|
|
Term
| What quadrant of the abdomen is the pain and discomfort of diverticular dz usually manifested? |
|
Definition
|
|
Term
| How is diverticulosis dx? Diverticulitis? |
|
Definition
-barium enema
-CT scan with oral and IV contrast (a barium enema or colonoscopy is CONTRAINDICATED in these pts due to the risk of perforation) |
|
|
Term
| What is a sign on a CBC of diverticulitis? |
|
Definition
|
|
Term
| What is the tx of diverticulosis? diverticulitis? |
|
Definition
-high fiber, low reside diet
-PO or IV abx depending on the severity, low residue or bowel rest diet, and analgesics |
|
|
Term
| Where can crohn's disease be located in the GI tract? What are the most common areas? |
|
Definition
-anywhere from the mouth to the anus
-the terminal ileum is one of the most common areas and it is predominantly R sided |
|
|
Term
| On colonoscopy/biopsy what does Crohn's disease look like? |
|
Definition
-skip lesions
-apthous ulcers
-cobblestone appearance
-transmural extensions to the entire bowel wall
-pseudopolyps |
|
|
Term
| Is smoking a RF for Crohns or UC? Is smoking protective in Crohns or UC? |
|
Definition
-rf for Crohns
-protective in UC |
|
|
Term
| Give some general s/sx of crohns disease |
|
Definition
| low grade fever, malaise, fatigue, abdominal pain (often RLQ), non-bloody diarrhea, cramping, |
|
|
Term
| What is the best test to dx crohn's? |
|
Definition
|
|
Term
| What is the general medical (not surgical) tx for Crohns disease/ |
|
Definition
-sulfasalazine (5-asa mesalamine is the main component) more helpful in UC and colonic issues but can be used here
-metronidazole if no help from 5-asa
-prednisone if refractory to the two above, add immunosuppressants if necessary |
|
|
Term
| What two things are absorbed in the terminal ileum and are therefore often malabsorbed in Crohn's disease patients? |
|
Definition
| B12 and Bile Acids (give a bile acid sequestrant for these pts) |
|
|
Term
| Is surgery ever used in pts with Crohns? Recurrence rate? |
|
Definition
| Yes, it is often necessary in all Crohns pts due to complications. BUT disease recurs in 50% of pts at 10 years post op |
|
|
Term
| Where is UC located in the GI tract? How does it spread? |
|
Definition
-always in the rectum
-travels from rectum proximally but the small bowel is usually not involved |
|
|
Term
| Describe how UC looks on colonscopy/biopsy? |
|
Definition
-its localized to the mucosa only (NOT transmural)
-uninterrupted involvement (NO skip lesions)
-PMNs accumulate in the crypts of the colon called crypst abscesses |
|
|
Term
|
Definition
| intermittent bloody, pus filled diarrhea, rectal urgency, tenesmus, fever, malaise, weight loss, abd pain |
|
|
Term
| What is the gold standard of dx of UC |
|
Definition
|
|
Term
| What is used to treat the acute exacerbations of UC |
|
Definition
|
|
Term
| What is the mainstay of tx for Crohns disease? |
|
Definition
| Sulfasalazine (5-ASA mesalamine is the active component) which helps to maintain remission |
|
|
Term
| Is surgery often implicated in UC? |
|
Definition
| Yes, a total colectomy is often curative unlike Crohn's |
|
|
Term
| Sclerosing cholangitis is a complication of UC, is it prevented by a colectomy? |
|
Definition
|
|
Term
| 1/2 of all _______ cancers are associated with UC |
|
Definition
| bile duct cancers (cholangicarcinoma) |
|
|
Term
| What is the MCC death in UC? |
|
Definition
| Toxic megacolon, affects <5% of UC patients |
|
|
Term
| What is the MC indication for surg in a crohns pt? |
|
Definition
|
|
Term
| What is a complication of Crohns that is not common in UC, most likely due to its transmural pattern? |
|
Definition
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|
Term
| Erythema nodosum is an associated complication with what type of IBD |
|
Definition
|
|
Term
| sclerosing cholangitis is a complication of what type of IBD |
|
Definition
|
|
Term
| Pyoderma gangreosum is a complication of what type of IBD |
|
Definition
|
|
Term
| What are the main serum labs to order to dx Celiac Disease (2)? |
|
Definition
-IGA anti-endomysial antibodies
-IGA tissue transglutaminase |
|
|
Term
| What will a small bowel biopsy of a pt with celiac disease show? |
|
Definition
| flattened villi (the reason for malabsorption) |
|
|
Term
| What is the tx of celiac disease? |
|
Definition
strict gluten free diet
-prednisone in refractory cases |
|
|
Term
| What drug's only indication is irritable bowel syndrome, and is a common pain reliever for IBS patients? What is the MOA? |
|
Definition
-Dicyclomine Hcl (Bentyl)
-its an antispasmodic and anticholinergic agent which alleviates smooth muscle spasm of the GI tract |
|
|
Term
| What is the tx for intussusception, peds vs adult? |
|
Definition
In peds the dx and tx is barium enema
in adults the dx is CT and tx is surg |
|
|
Term
|
Definition
| In intussusception, a sausage shaped mass in the R hypochondrium and emptiness in the RLQ |
|
|
Term
| Of the three types of colonic polyps, rank them from least to greatest, with risk of carcinoma |
|
Definition
| tubulous< tubulovillous< villous |
|
|
Term
| What are the three most common sites of colon cancer mets? |
|
Definition
| Liver, lung, and peritoneum |
|
|
Term
| When should a pt who does not have any close family hx of colon cancer have their first colonoscopy? How often after that? |
|
Definition
|
|
Term
| in a pt with a first degree relative who had colon ca, when should they get their first colonoscopy? |
|
Definition
| ten years before the age of diagnosis of that first degree relative |
|
|
Term
| anal warts are caused by which strains of HPV? anal cancer is caused by which strains? |
|
Definition
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