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GI Review 2 (CM)

A screening colonoscopy in a patient 50 years or older with an average risk of colorectal cancer should be done: every 10 years*
To diagnose acute pancreatitis order Serum amylase & Lipase*
2-4 wk old infant with intermittent, non-bilious projectile vomiting most likely has? pyloric stenosis*
This is the most frequent cause of intestinal obstruction in 3-12 month old? intussusception*
Always think of Projective Vomiting in young infant pyloric stenosis
Diagnosis of pyloric stenosis is by UGI series or ultrasound
Treatment of pyloric stenosis involves pyloromyotomy
Intestine telescopes in on itself Intussusception*
Bloody bowel movement seen during Intussusception is called Currant Jelly Stools*
This mass is pathognomonic for intussusception Sausage shaped mass*
Hirschsprung Disease is failure to pass meconium that results in functional obstruction and massive dilation of colon
Pathophysiology of intussusception Invagination of portion of intestine into itself
Treatment for Wilm's tumor surgery
Diagnosis for Intussusception is via Barium enema (is diagnostic and therapeutic)
Lanugo fine hair on the face
People on corn (maize) diets Niacin deficiency (pellagra)*
Niacin deficiency AKA Pellagra*
3 D's of pellagra Diarrhea, dermatitis, dementia*
Folate deficiency causes this type of anemia macrocytic anemia
This nutrient plays a key role in nucleic acid synthesis Folate*
Early manifestations of this deficiency include occlusive vascular disease and thrombosis Folate deficiency
Vitamin B1 deficiency AKA Thiamine deficiency
Causes beri beri, mostly in malnourished and alcoholics Thiamine deficiency (B1)*
Thiamine deficiency (B1) manifests with acute heart failure, neurologic deficits, and epilepsy*
Cobalamin deficiency AKA Vitamin B 12 deficiency*
Cobalamin deficiency manifests as this anemia macrocytic anemia
Cobalamin deficiency (Vit B 12) manifests with peripherial neuropathy, parasthesias & demyelination of the corticospinal tract
Vitamin B6 deficiency AKA Pyridoxine deficiency*
Pyridoxine (B6) deficiency presents with peripheral neuropathy, seborrheic dermatitis, glossitis and cheilosis*
Deficiency that causes hemolytic anemia in premature infants Vitamin E deficiency
Define Cullen's sign Ecchymosis around the umbilicus*
Define Grey Turner's sign Ecchymosis around the flanks*
Lisker's sign Tibial bone tenderness that can sometimes be illicited with DVT*
Kehr's sign Pain in the left shoulder secondary to splenic rupture
Abdominal rebound tenderness that indicates peritoneal irritation is what sign Blumberg's sign
This marker is present during the window period of Hep B HBcAg*
The first serological marker to appear in Hep B infection HBsAg*
HBeAg is a marker for Infectivity with Hep B*
Is the hepatitis B core antigen HBcAG*
Is seen at the end of an infection with Hep B and gives immunity Anti-HBs*
History of portal hypertension/ liver disease think Esophageal varices*
Dx & Tx of esophageal varices Endoscopy
Pyrosis is Heartburn
Dysphagia of solids and liquids Achalasia*
'birds beak' occurs in Achalasia*
Dx of achalasia is made via Esophageal manometry*
Transient cystic duct obstruction Biliary colic*
Female, fertile, forty, fat Cholelithiasis*
Common bile duct stone Choledocholithiasis*
Sustained obstruction of cystic duct Acute cholecystitis*
Skip lesions are found in Crohn's disease*
'string sign' occurs in Crohn's disease*
Cobblestoning is seen in Crohn's disease
Treatment of Crohn's disease Sulfasalazine*
Dx and Tx of mesenteric ischemia via Angiography
Second most common cancer death in men and women Colon cancer
Apple core lesion on barium enema indicates Colon cancer*
Beri beri is seen in this vitamin deficiency Thiamine deficiency*
Most common complication of portal hypertension esophageal varices
Corkscrew on Barium swallow Esophageal spasm*
Esophageal Cancer associated with smoking Squamous cell carcinoma*
Esophageal Cancer associated with alcohol Squamous cell carcinoma*
Esophageal Cancer associated with Barrett's Adenocarcinoma*
Diagnosis of GERD is by Barium swallow
Diagnosis of peptic ulcer disease (PUD) is by Upper endoscopy
Gastric adenocarcinoma has a strong connection with H. pylori and smoking
First sign of intestinal obstruction is Hyperactive bowel sounds
Diagnosis of celiac disease Mucosal biopsy*
Most common abdominal cancer in children neuroblastoma*
Most common cause of upper GI bleed PUD*
Double bubble sign Duodenal atresia
Hirschsprung's disease AKA Congenital megacolon*
This is caused by the congenital abscense of Meissners and Auerbach's autonomic plexuses enervating the bowel wall Hirschsprung disease
A congenital aganglionosis of the colon Hirschsprung disease
Treatment for ascities Salt restriction & bed rest*
Common complication seen in crohn's disease Fistulas*
MCC of gastroenteritis in children Rotavirus*
MCC of constipation in kids Functional (voluntary withholding or diet)*
Epigastric mass in a child 2-4 weeks old, is most suggestive of Pyloric stenosis*
Pernicious anemia is associated with what cancer Gastric cancer*
Cancers of skin, esophagus or mouth are usually Squamous cell carcinomas
Pain worse after eating, think Gastric PUD
Pain relieved with food or antacids Duodenal PUD
Zollinger-Ellison syndrome is a Gastrinoma*
Liver drains into the Hepatic duct
Gall bladder drains into the Cystic duct
Pancreas drains into the pancreatic duct
Common bile duct drains into the duodenum
The hepatic duct, cystic duct, & pancreatic duct all drain into the Common bile duct
Two causes of unconjugated bilirubinemia Hemolysis & Gilberts syndrome
Murphy's sign is seen in Acute cholecystitis*
Primary sclerosing cholangitis presents with Fatigue, jaundice, puritis, pain*
Primary sclerosing cholangitis is Chronic inflammation & fibrosis of the bile ducts
Fe overload is associated with Hemochromatosis*
Cu overload is associated with Wilson's disease*
Major risk factor for hepatocellular carcinoma Hepatitis B*
Hepatitis seen in India, SE and central Asia Hep E
Crohn's disease typically involves the Terminal ileum & cecum*
Air/ fluid levels on abdominal upright KUB Small bowel obstruction
LLQ Pain & mass, fever, leukocytosis indicates Diverticulitis*
Diagnosis of diverticulitis is Clinical based
UC always involves the Rectum*
With Celiac spruce, the patient can eat CRAP: Corn, Rice, Aeroroot, Potato*
Deficiency of vitamin D leads to Osteomalacia
A gastric hormone that activates duodenal/ jejunal receptors to initiate peristalis motilin
What acid base disorder is seen with mesenteric Ischemia Metabolic acidosis
Abdominal pulsatile mass Abdominal aortic dissection
Colicky periumbilical pain that becomes constant in RLQ Appendicitis*
Disease with RUQ pain that radiates to scapula tip Cholecystitis*
+ Kehr's sign Splenic rupture*
Left shoulder pain secondary to subdiaphragmatic irritation is due to splenic rupture*
+ Lloyd's sign Pyelonephritis*
Signs in pancreatitis Turner's & Cullen's signs*
current recommendation for colon cancer screening FOBT yearly, sigmoidoscopy every 5 years & colonoscopy every 10 years
Inability to hold feces in the rectum Fecal incontinence
The reflux of food and stomach acid back into the mouth, brine-like taste Regurgitation
Absence of bowel activity (and bowel sounds) due to a direct insult to the gut Paralytic ileus
Serous fluid accumulation in the abdominal cavity, from cardiac or liver disease Ascites
Define Murphy's sign Pain over the gallbladder as you press as the patient inspires*
(+) Murphy's sign cholecystitis*
Point tenderness over McBurney's Point indicates Appendicitis*
Define Psoas sign Pain as patient raises right leg against resistance
Define obturator sign Pain as you flex patient right hip and internally rotate
Define Rovsing sign Right side pain with left side pressure
Inflammatory bowel disease that increases risk for colon cancer Ulcerative colitis*
Tenesmus Feeling of incomplete evacuation of the rectum
Raised tender red purplish nodules seen in IBD Erythema nodosum
Tenesmus is suggestive of Proctititis
95% of colon cancers are Adenocarcinomas*
Colon cancer metastasizes to the Liver and then the lung
Rectal cancer metastasizes to the Liver or lung
Most common type of Abdominal pain, is general and/or undiagnosed abdominal pain
Cholelithiasis (ultrasound or CT) ultrasound
treat diarrhea with fluoroquinolone
High-sensitivity fecal occult blood test (FOBT), which checks for hidden blood in three consecutive stool samples, should be done every year (no meat for 5 days)
indicates active or ongoing infection Hep B infection Hepatitis b surface antigen (HBsAg)
Most sensitive test for diagnosis of iron deficiency anemia? A low serum ferritin
Antibiotics can cause C.diff colitis
Most common complaint of abused children Abdominal pain
WBCs seldomly over 15,000 Appendicitis
Pyloric Stenosis can develop in neonates
Reynold's pentad indicates Cholangitis*
Reynold's pentad includes Pain, fever, jaundice, hypotension, & mental confusion
Charcot's triad includes RUQ Pain, fever (>40), jaundice
Classic history of painless jaundice is seen in Pancreatic cancer*
Define cholangiocarcinoma Cancer of bile duct wall
'Beads on a String' is seen in Primary sclerosing cholangitis (PSC)
Diverticulosis most commonly affects the Sigmoid colon*
Define acute diarrhea Less than 6 weeks in duration, mostly due to viral infections
Define chronic diarrhea More than 6 weeks in duration
Bulky, frothy, oily stools think Fat malabsorption
Difficulty swallowing Dysphagia
Painful swallowing Odynophagia
Split, tear or erosion in epithelium of anal canal usually due to large or hard to pass stools Anal fissures*
Anal fissure are usually located Posteriorly*
Parietal cell secretes HCL
Sister Mary Joseph nodes are seen in Gastric cancers*
Two most common causes of PUD H. pylori & NSAIDs
Define anal fistula Abnormal opening between anal canal & perianal skin
Painless bleeding after defecation Internal hemorrhoids
Triad of malabsorption disease Chronic diarrhea, weight loss & nutritional deficiency
Gold standard test for malabsorption Quantitative stool fat test
Inflammatory response of small bowel to ingestion of gluten proteins found in wheat, rye, & barley Celiac disease
Cutaneous variant of celiac disease Dermatitis herpetiformis*
Intensely pruritic papulovesicular rash of trunk, scalp, & extremities seen in celiac disease Dermatitis herpetiformis
Most common malignancy associated with celiac disease Lymphoma
Inflammatory disease of small bowel secondary to overgrowth of coliforms Tropical spruce
Hyperparathyroidism can cause this GI issue Acute pancreatitis
Peutz-Jeghers syndrome Melanin spots on the lips, buccal mucosa & tongue and bleeding polypoid lesions in the small intestines
Rendu-Osler-Weber Telangestagias on the face and buccal mucosa and similar lesions in the GI tract
Blue - Rubber-Bleb-Nevus Cavernous hemangiomas of the skin and similar lesions in the small intestines
Neurofibromatosis Café au late pigmentation with peduncalated fibromas and bibromas in the GI tract that may bleed are associated with
More than 50% of cases of pill induced esophagitis results from Tetracycline
Describe Markle sign or jar sign Have patient stand on toes and then drop quickly to heels to find location of abdominal pain
Another name for rebound tenderness Blumberg sign
Cullen's sign is associated with Retroperitoneal bleeding & pancreatitis
Pregnancy is associated with improvement in migranes and PUD
Microcytic anemia in a patient that is over 50 year old, think Colon cancer
40 % of advanced neoplasms in colon are located Proximal to the splenic flexture
Colonoscopy for IBD patients is done Yearly, 8 years after diagnosis
Alcoholic fatty liver presents with RUQ pain, tender hepatomegaly and elevated transaminase levels
Inflammatory polyps are associated with which IBD Ulcerative colitis
Define esophageal varices Dilated submucosal veins in lower esophagus
Hematemesis with severe retrosternal 'tearing' pain Boerhaave's syndrome
Complains of dysphagia/ odynophagia; get an Endoscope (EGD)
Nonpropulsive hyperperistalysis of esophagus Diffuse esophageal spasm (DES)
Schatzki rings Smooth, circumferential structures in the distal esophagus
Esophageal web may result from Iron deficiency anemia
White male with long standing GERD Barrett's esophagus
Treat Barrett's with Long term PPIs / ablation
Best test & most cost effective for H. pylori diagnosis Stool antigen*
H. pylori treatment Amoxicillin, clarithromycin & a PPI*
H. pylori treatment for PCN allergic patient Metronidazole, clarithromycin & a PPI*
Zollinger Ellison syndrome is seen with Recurrent PUD, PUD with hypercalcemia and a serum gastrin level above 150
Most common cancer world wide Gastric cancer*
Peptic ulcer disease where patients lose weight Gastric ulcer disease
Peptic ulcer disease where patients gain weight Duodenal ulcer disease
Jaundice occurs at a total bili of Above 3
labs in Gilbert's disease show Increased total bili, increased indirect, decreased direct
Primary sclerosing cholangitis is often associated with UC (IBD)*
Most common etiologies of acute pancreatitis Gallstones & ETOH abuse
Helpful tumor marker for pancreatic cancer CA 19-9*
Painless jaundice Pancreatic cancer*
Treatment for hemochromatosis Weekly phlebotomy
Kay-Fleischer ring on eye exam Wilson's disease
Treat Wilson's disease with Penicillamine
ALT >> AST (20 times elevated) Viral hepatitis
Most common indicator for liver transplant Hep C*
Most common blood borne infection Hep C*
Leading cause of chronic liver failure Hep C*
Most common metastatic cancer Hepatocellular neoplasm*
Tumor marker for Hepatocellular neoplasm AFP*
Patients with celiac spruce cannot eat NO BROW: Barley, rye, oats wheat
MCC of lower GI painless bleeding in patients above 50 Diverticular hemorrhage*
Most common area for diverticulosis Sigmoid colon*
Second most common cause of cancer death Colon cancer*
Indirect inguinal hernia Goes through the internal inguinal ring
Direct inguinal hernia Through the back wall of the inguinal canal
Femoral hernia Protrusion through the femoral ring
Hiatal hernia Stomach/ intestines protrudes into chest cavity through diaphragm defect
Hemochromatosis trait is Autosomal recessive
Hemophilia A & B trait is X linked recessive
Child swallowed Drano, what to do Lavage (anything toxic)*
Cell change in Barrett's esophagus is from Squamous to columnar epithelium
Outpouching of the upper esophagus Zenker's diverticulum
Rosary bead appearance in esophagus Diffuse esophageal spasm
Tumor marker for pancreas CA 19-9*
Tumor marker for liver AFP*
Tumor marker for colon CEA*
Tumor marker for ovarian CA 125*
Tumor marker for prostate PSA*
Which types of hepatitis are acute Hepatitis A & E
Which types of hepatitis can become chronic Hepatitis B, C & D
Which types of hepatitis are transmitted via the fecal oral route Hepatitis A & E
Which types of hepatitis are transmitted by blood & body fluids Hepatitis B, C & D
Tumor marker for seminoma testicular cancer HCG*
Tumor marker for non-seminoma testicular cancer AFP*
Best test to evaluate the livers synthetic functions Prothrombin time & INR
Diabetes in a young person with a GI complaint gastroparesis
common causes of food-borne toxin-induced diarrhea Staphylococcus aureus, clostridium perfringens, and bacillus cereus
Daycare associated diarrheal illness rotavirus
vitamin B2 aka riboflavin
Cardiomegaly and congestive heart failure with a high cardiac output is associated with a deficiency of thiamin (vitamin B1)
H2-Receptor Antagonists (H2RAs) include Cimetidine, ranitidine, Famotidine & nizatidine
MOA of H2-Receptor Antagonists (H2RAs) Inhibit gastric secreation by blocking histamine (H2) receptors on parietal cell
uses of H2-Receptor Antagonists (H2RAs) Dyspesis, GERD, PUD
ADRs of Cimetidine drug fever, ED & gynecomastia
Proton Pump Inhibitors (PPIs) include Omeprazole, lansoprazole
MOA of Proton Pump Inhibitors (PPIs) Inhibits parietal cell H/K ATP pump
PPIs should be administered 30 to 60 minutes before first meal
uses of Proton Pump Inhibitors (PPIs) GERD, PUD, Zollinger Ellison syndrome, H. pylori
ADRs of Proton Pump Inhibitors (PPIs) iron deficient & pernicious anemia, fractures
Four neurotransmitter sites important in the vomiting reflex Inner ear (M1: Muscarinic; H1: Histamine) & Systemic (D2: dopamine, 5-hydroxytryptamine 3: serotonin)
uses of Dimenhydrinate (dramamine) motion sickness
All febrile patients admitted with ascites must have this performed Abdominal paracentesis
Diagnosis of Mallory Weiss tear with Esophagogastroduodenoscopy (EGD)
Esophageal varices presents with Hematemesis, melena & hematochezia
Treat esophageal varices with EGD, variceal banding; Sclerotherapy
Long term treatment of esophageal varices Beta blockers, No ETOH
Boerhaave's syndrome is secondary to Instrumentation (EGD)
Pill induced esophagitis caused by NSAIDs, KCl, Alendronate (Bisphosphonate) Doxy (tetracyclines)
Treat Achalasia with Botox injections at LES, myotomy
Diagnosis Zenker's Diverticulum with Barium esophagram
Esophageal web causes connective tissue effect called Plummer Vinson syndrome
Treat esophageal web by Treating iron deficiency anemia
Diagnosis for esophageal cancer Endoscopy with biopsy
50% of patients with GERD develop Reflux esophagitis
GERD presents with Heartburn, regurgitation, nausea, throat irritation & cough
Heartburn exacerbated by meals, bending over, recumbency, relaxes LES & weight gain GERD
Workup for GERD 4 weeks on PPIs, test for H pylori
Complicated disease or alarm symptoms with GERD GI bleeding, anemia, dysphagia, odynophagia, wt. loss, NSAID use, ulcer disease
In unresolved GERD do Endoscopy, pH monitoring, fundoplication
Screening in Barrett's Endoscopy every 3 - 5 years
EGD shows orange/ salmon colored changes to mucosa Barrett's esophagus
Most common PUD Duodenal
Age for duodenal peptic ulcer disease 30 - 55 y/o
Age for gastric ulcer diseased 50 - 70 y/o
PUD is more common in NSAID and H. pylori infection
Risk factors for NSAID Gastropathy Age, Hx PUD/ bleed, NSAID overuse, concomitant corticosteroid tx
Red flags to get and EGD Anemia, weight loss, + hemoccult stools, hematemesis, melena, persistent vomiting, dysphagia
Treatment for PUD if under 50 and no red flags PPI for 4 weeks, check H. pylori
Gold standard diagnosis for PUD Endoscopy (EGD)
Do not have to rescope this ulcer Duodenal ulcer
Treatment for gastric ulcer PPI bid for 1 month; PPI qd for 1 month; and rescope after 6 -8 weeks
Complications of PUD Perforation, gastric outlet obstruction, bleeding
Normal level of total bilirubin 0.2 - 1.2
Elevated bilirubin levels are due to Abnormal formation, transport, metabolism & excretion
Bilirubin levels in Choledocholithiasis Increased total bili, increased direct, decreased indirect
Most common stones in Cholelithiasis Cholesterol
Common symptom of biliary colic Nocturnal pain
Acute cholecystitis presents with Intense persistent pain, n/v, fever, murphy's sign
Acute cholecystitis labs show Leukocytosis with a left shift
Female with generalized fatigue, jaundice & puritis Primary biliary cirrhosis
Diagnosis of primary biliary cirrhosis by Liver biopsy, + AMA (anti-mitochondrial antibody)
Treatment of primary biliary cirrhosis Bile acid sequestrates (URSOdiol), transplant
Diagnosis of autoimmune hepatitis Increased AST/ALT, + ANA (anti-nuclear antibody), + ASMA (anti-smooth muscle antibody)
Treatment of autoimmune hepatitis Prednisone/ immunomodulators (azathioprine)
PSC leads to End stage liver failure
Nontender palpable gallbladder with history of weight loss Cholangiocarcinoma
Klatskin tumor most commonly occurs at Junction of right & left main hepatic ducts
Cancer associated with primary sclerosing cholangitis Cholangiocarcinoma
Meds that cause acute pancreatitis Azathioprine, pentamide, valproate, thiazides
Acute pancreatitis presents with Sever epigastric pain, n/v, tachycardia, orthostasis, dehydration, hypotension
Diagnosis of acute pancreatitis Increased serum amylase & lipase, leukocytosis with left shift, CT
ICU admission of acute pancreatitis if AMS, hypoxemia, HCT >50, oliguria, tachycardia with hypotension
Ranson's criteria is for Necrotizing pancreatitis
Ranson's criteria includes Age > 55, WBC > 16,000, BS > 200, LDH > 350, AST >250 & low serum calcium
Most common area of pancreatic cancer Head of pancreas
Diagnosis of pancreatic cancer with CT & CA 19-9
Pancreatic cancer presents with Vague epigastric pain straight through to the back, painless jaundice, weight loss, anorexia
Hep A infection possible if patient has Foreign travel, flooded area of US, or poor sanitation
Vaccinated patient to Hep B will show positive to Anti HBsAg only
Immunity (recovered) patient to Hep B shows + Anti HBsAg; + Anti HBcAg; (+/-) Anti-HBe
Chronic active Hep B shows (+) HBsAg; (+) Anti HBsAg; (+) Anti-HBe
Chronic active infections of Hep B (+) HBsAg, (+) Anti-HBcAg,(+) HBeAg
Always done to confirm Hep C liver biopsy
Treatment for Hep C Pegylated interferon with ribavirin
MCC of cirrhosis Alcoholic hepatitis
Confirm non-alcoholic fatty liver (NASH) with Liver biopsy
Hepatocellular neoplasm mets to Lung, colon, breast & prostate
Manage Crohn's or UC with Aminosalicylates/ 5ASA (mesalamine) to Immunomodulators (azathioprine) to biologics
Risk of infection with disease with IBD meds with Immunomodulators/ biologics
Biological therapies include Remicade, humira, cimzia
Aminosalicylates/ 5ASAs include sulfasalazine
ADR of Azothioprine (Imuran) Pancreatitis, check LFTs/CBC every 90 days
Immunomodulators used in IBD Azothioprine (Imuran)
MCC of small bowel obstruction Previous surgery (adhesions)
Treatment for small bowel obstruction NG tube, Bowel rest
50 y/o with history of atherosclerotic heart disease, hypoperfusion of the bowel vasculature mesenteric ischemia
Secondary to removal of small intestines Short bowel syndrome
If more than 50 cm of Ilium is resected patient needs Monthly B-12 injection
Acute, painless, large volume maroon or BRB in pt. > 50 y/o Diverticular hemorrhage
Treat diverticular hemorrhage with Metronidazole & ciprofloxacin for 10 -14 days
Precedes most colon cancers Adenomas
Hernia with a history of previous surgery Incisional
Causes of lower GI bleed in patients < 50 Infectious colitis, IBD, fissures, hemorrhoids
Group A streptococcus pharyngitis presents with Fever, absences of cough, tender cervical lymphadenopathy, & tonsiller exudates
Primary sclerosing cholangitis leads to Cholestatic liver disease
SE of cimetidine (Tagamet) HAs, Dizziness, skin rashes, loss of libido & gynocomastia
Secretin inhibits Release of gastrin
Created by: duanea00