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Random GI CMI

CM1-Fall 2011

Role of Cox1? Cox2? 1 = Regulates GI mucosal integrity 2 = Regulates inflammation
Stress gastritis most likely d/t? Mucosal ischemia d/t decrsd gastric blood flow
Is a GU or DU more likely to be H.pylori+? DU
NSAID/ASA use is more likely to cause an ulcer where? Gastric
When does pain occur w/ GU and DU? GU=soon after meals DU=2-5 hrs after meal
Which ulcer is more likely to wake pt up at night? DU
Which ulcer type is more likely to be better with food? DU (GU may or may not)
Early satiety and post-prandial fullness is assoc with? Dyspepsia
Which tests for H.pylori should you use (and they distinguish bw active vs non-active infection) -Fecal antigen immunoassay -Urea breath test (not serology)
What is Zollinger-Ellison syndrome? Hypergastrinemia and acid hypersecretion d/t gastrin-secreting neuroendocrine tumors
Multi-step progression to CA? Gastritis>Atrophy>Metaplasia>Dysplasia>CA
MAJOR risk fx for gastric CA? H.pylori
What is the primary and secondary peristalsis involved w/esophageal swallowing? Primary- Vagal stretch receptors in the wall of the esoph detect distension and induce a vagovagal response secondary-another wave of peristalsis that clears the food from the esophagus
>90% of pts w/barrets esoph have? Hiatal hernia
What is the name of the syndrome involving esophageal perforation into the chest cavity? Boerhaave's syndrome
esophageal rings are assoc w/ what? (in almost all cases)? Hiatal hernia
review hormones in intro to GI :) :)
Cascade of protein breakdown? Protein>ammonia>urea>Elimination
Initial presentation hepatitis? "Flu-like"
Which liver enzyme is also in bone, intest, placenta and needs to be confirmed with what? Alk Phos -Confirm with GGT
What aminotransferases >5000..think? Acetaminophen
Which heptitis has the greatest chance of developing in IVDUs? HepC
The majority of those infected with which hep progress on to chronic dz? HepC
HCV "types" (genotypes)? 1-6 (70% in US = 1) -1 is the least responsive to tx
What is the chief cause of cirrosis and HCC? Chronic HBV
What are the phases of chronic HepB? 1. Immune tolerant 2. Chronic Hepatits 3. Inactive carrier 4. HBeAg- Chronic hepatitis
What is stage 4 of fibrosis? Cirrhosis
What is the most common cause of fulminant hepatic failure? Acetaminophen poisoning (>10g)
Liver enzyme levels in autoimmune hepatitis? -AST and ALT elevated -Alk Phos and GGT nL -^ bilirubin
What is the hallmark of AIH? Hypergammaglobulinemia (IgG) >2x ULN
MC single gene d/o inherited in US? Hereditary Hemochromatosis (Autosomeal recessive) *HFE gene (^^Iron)
Role of transferrin? Helps carry iron in the body
Form that iron is stored in, in body? Serum ferritin
What is the autosomal recessive d/o of copper metabolism? -Wilson's disease
What should you suspect in a young pt with liver failure? -Wilson's dz (dz of the young: usually 12-23 y.o.s)
When might you see Kaysar-Fleischer rings? Wilson's dz
What is the inherited d/o that can cause lung and liver dz? a-1 antitrypsin deficiency (MM=normal, ZZ=assoc w/ cirrhosis, MZ=lung or liver dz)
What is the MC metabolic indication for liver transplant w/ an excellent outcome? a-1 antotryps deficiency
Standards for malnutrition? 85-90% Mild malnut 75-85% Mod <75% Severe
Wt loss concern*? 10% over 6mo or >10# in 6mo
What is the test of choice for protein assessment? Pre-albumin
Top Vitamin defic in US? VitA,C, Iron, Ca2+ (maybe folic acid, too)
What is the only water-soluble vitamin that is substatially stored? B12
What mineral is involved as a depletion complication of aggressive refeeding? Phosphorus and Mg
What is the relationship bw folic acid and B12? Folic acid (supps) can mask B12 deficiency
What is the relationship bw neomycin and Vit K?> Neomycin can decrease the absorption of Vit K
Vit A deficiency symptoms? Night blindness, blindness, corneal ulceration, etc other ophthalmic probs
Vit A toxicity? Vertigo, dermatitis, diplopia, seizures, dry skin, glossitis, alopecia, bone demineralization,amenorrhea
Vit D (cholecalciferol) defiency? Rickets - structural abnormalities in growing bones -Osteomalacia and osteoporosis
Vit C (ascorbic acid) deficiency? Scurvy - bleeding gums, petechiae
Vitamin B1 aka? Defic? Thiamine -Beri Beri (common defic in alcoholics) =Weak, anorexia, memory loss, muscle wasting..
Vitamin B2 aka? Symptoms of deficiency? -Riboflavin -Magenta tongue, cheilosis
Vitamin B3 aka? Defic? Niacin -Pellagra: 4 D's: -Dermatitis, Dementia, Diarrhea, Death (sun=Casal's necklace)
What happens w/ iodine defic? Mom gives birth and child has Cretinism = severe MR
Glucocorticoids can cause weight gain, central fat, and what else? Decrsd protein synthesis
What is the state of general protein deficiency called? Kwashiorkor
What is recognized as the most common chronic liver dz in the western world? NAFLD (major RF=obesity)
What are the probable primary pathogenic fxs in steatosis? Insulin and leptin resistance
2ndary causes of NAFLD? Polycystic ovary syndrome, drugs, toxins, nutritional
When would you see acanthosis nigrans? NAFLD
What is the test that uses US waves to measure the liver stiffness in NAFLD? Fibroscan (transient elastography) [Reliable for assessing liver fibrosis]
Assessing maladaptive patterns of alcohol use? RISK of bodily harm; RELATIONSHIP TROUBLE; ROLE FAILURE; RUN-INs w/ the law
Which vitamins are recommended for chronic alc liver dz assoc w/PCM? -Thiamine and folate
TX options for severe alc hep? Corticosteroids, pentoxifylline (may decrs renal failure)
Initial treatment therapy for ascites? Na+ restriction (diuretics?)
Transudate vs. exudate in ascites? Transudate=low protein=liver failure Exudate=high protein=CA
Surveillance in cirrhosis is done with an ultrasound q6mo..why? HCC dbling time = 6mo
What are the early lesions called from which most CRCs arise? Adenomatous polyps
Who gets CRC? MC is sporadic! -Familial, genetic predisposition
What is the time for devt of adenomas to CA? ~7-10 yrs
Which other CAs are assoc w/CRC and what should be done? Ovarian and endometrial CAs -Screen q5 yrs beginning at age 40
Familial adenomatous polyposis involves? >100 polyps
Colonoscopy = preferred test for CRC, start at age 50, except for? Af Ams start at age 45
Screening rec's for pts with h/o colitis? Initiate screening 8-10 yrs after the onset of sxs of colitis/IBD; colonoscopy q1-2 yrs
What glycoprotein test can be used if pt has KNOWN CRC and rises usually w/ CR tumor cells that have penetrated thru the bowel wall? CEA
What odd things may decrs risk of UC? Smoking, appendectomy
Bloody diarrhea is hallmark of dx for which IBD? UC
String sign in which IBD? CD
Loss of haustral markings in which IBD? UC
Toxic megacolon in? UC
Bile stones, kidney stones, canker sores, and erythema nodosum complications of? CD
Which symptom implies proximal bowel involvement? Vomiting
Vomiting w/o diarrhea cannot be called what? Gastroenteritis
MC bacterial cause of toxigenic infectious diarrhea? E.coli
50-70% of all infectious viral diarrhea? Norwalk Virus
Stool characteristics of SB issues? -Watery -Large amount -Frequent -Not usually bloody
Stool characteristics of LB issues? -Mucoid/bloody -Small -frequent -possibly grossly bloody
Which is the "common human bacteria" that results from toxin produced in contam food stored at room temp? Staph aureus
Which pathogen is considered the "cafeteria germ" and results d/t food make in large quantities.."24-hr flu"? Clostridium perfringens
Pathogen produced in improperly canned foods and can be fatal? Clostridum botulinum (progressive paralysis of resp system)
Which FBI pathogens can be FATAL? Clostridium botulinum, E coli, Listeria monocytogenes, Salmonella
common cross-contam pathogen? Salmonella
Which pathogen may not make you "sick" for up to 30 days post ingestion? Also can result in fetal loss, (usually hospitilization), relation to mexican chz and frts? Listeria monocytogenes
Human fecal matter pathogen? Shigella
Parasite seen in wide game and causes muscle wkness? Trichinosis parasite
What is most likely to rebleed? Esophageal varices
MC cause of UGI bleed? GU/DU
MC cause of true LGI bleed? Diverticulosis
What can "stimulate" melena? Bismuth, iron (and CHECK TONGUE!)
What is a very sensitive test for GI bleeds? Technicium-labeled RBC scan
primary management of acute GI bleed? O2, Intubate?, IV, cardiac monitor, transfuse?, NG!
Rovsing's sign? Palpate LLQ and causes RLQ pain
RFs for cholecystitis/lithiasis? Fat, Female, Fertile
If suspect cholecystitis/lithiasis and tests are not adding up, can do? Hida Scan--Radionuclide IV isotope given....taken up by NL gb, but not in cholecystitis d/t inflamm
Charcot's triad? For ascending cholangitis: Fever, Jaundice, RUQ pain; life-threatening bc bacteria get into hepatic vein and to systemic circulation
When to do plain Xray (flat and upright) for abd pain? -Perf ulcer (looking for free air) -SBO
Pancreatitis and hypoCa2+? Inflammed pancreas may suck in all Ca2+
VODKA? BO: Vomiting, Obstipation (not passing stool or gas), Distention, Krampy Abd pain
Thumb-printing? Ischemic bowel on XR showing bowel wall thickening
Collins sign? Pain w/ cholelithiasis that radiates to the right scapular tip
Medication that helps dissolve gallstones? Ursodiol
Cholecystitis is differentiated from biliary colic how? constant severe pain for >6hr
MC cause of cholangitis? Choledocholithiasis
Pancreatic enzymes packaged into storage vescicles called? Zymogens
Discomfort is more intense when in pancreatitis? Supine postition
Cullens and Turner signs in acute pancreatitis? C=bluish discoloration around umbilicus T=bruising of the flanks
MC causes of chronic pancreatitis? Adults=alcohol Kids=CF
DX of chronic pancreatitis? -Secretin stimulation test -MRCP
Intermittent/bolus tube fding is only suitable for? Gastric feedings (NG or PEG)
In PN, what are the forms of fat, protein, chos? TGs, Free aa's, Dextrose
Allergies assoc with PN? Eggs, soy (d/t the lipids)
In PN, bicarb is not stable, and is replaced w/? Acetate
Possible prophylactic to prevent phlebitis w/PPN? Heparin and hydrocortisone??
What complication is more commin w/femoral hernias? Incarceration bc smaller opening
MC abscesses? Perianal (complication = fistula formation)
MC sources for supralevator abscess? PID, Diverticulitis, Appendicitis
For risk of perforation, avoid what in diverticulitis? NSAIDs, Steroids
Studies suggest that a diet high in what can help prevent progression of diverticulosis? Fiber
Vitamins that should be supp to alcoholics? Folic acid, thiamin, vit B12, vit K
No what with celiac dz? Wheat, Rye, Barley, Oats
Colon CA RFs? -Low Ca2+ and folic acid -Alcohol(beer) -High meat intake -Obesity
Created by: ferrier.kath
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