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GI HIGH YIELD

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laracrystalo's version from 2016-07-17 21:22

1

Question Answer
too much smoked foods?gastric adenocarcinoma (intestinal type)
too many hot beverages?squamous cell carcinoma of esophagus
transverse ringseosinophilic esophagitis
odynophagiacandida
white plaquescandida / eosinophilic esophagitis
dysphagia to solids onlystructural disorder, a blockage
dysphagia to solids and liquidsmotility disorder
rapid progressive dysphagia to solids --> liquidscarcinoma
gradual progressive dysphagia to solidspeptic stricture
intermittent dysphagia to solidsesophageal webs, rings
progresive dysphagia to both solids and liquids with heartbrnscleroderma
progressive dysphagia to both solids and liquids without heartburn achalasia
intermittent dysphagia to solids and liquids with intermittent heartburnesophageal spasm
bird's beak signachalasia
treatment for achalasia?myotomoy, botulinum, balloon dilation
ground glass nucleiherpes esophagitis
signet cell ringsdiffuse gastric adenocarcinoma
linitis plasticadiffuse gastric adenocarcinoma
krukenberg tumorsdiffuse gastric cancer spread to bilateral ovaries
foamy PAS filled macrophageswhipple disease
HLA DQ2 and DQ8Celiac sprue
defect in chylomicron exportationabetalipoproteinemia
MALT lymphomaH. pylori infections increase risk
vitamin A deficiencyhyperkeratosis, night blindness
vitamin D and Ca++ deficiencytetany (contractions of hands) and osteomalacia (thinning of bones)
vitamin E deficiencyneuropathy
Vitamin K deficiencyecchymoses (bruises)
Vitamin B 12 deficiencyanemia, glossitis, cheilosis (red tongue and lips), neuropathy
folate deficiencyanemia, glossitis
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2

Question Answer
iron deficiencyanemia, dyspnea, fatigue, glossitis
increased risk of T cell lymphomaceliac sprue
decreased IgAceliac sprue
dermatitis herpetiformisceliac sprue
migratory thrombophlebitistrousseau sign with pancreatic adenocarcinoma
acute painless jaundice and dilated gall bladdercourvoisier sign in pancreatic adenocarcinoma
whipple procedureremoval of head/neck of pancreas, gallbladder, duodenum. Treatment for pancreatic adenocarcinoma.
elevated lipase/amylaseacute pancreatitis
puestow proceduresurgical drainage of pancreatic duct for chronic pancreatitis
+ murphy signacute cholecystitis
pain radiates to R sub scapulagall bladder (normally epigastric)
pain radiates to mid backpancreas (normally epigastric)
pain radiates to shoulderliver (normally epigastric)
low fiber diets are a risk for?cause diverticulosis
pancreatic condition associated with downs syndromeannular pancreas
enlarged supraclavicular nodevirchow's node in pancreatic adenocarcinoma
samter's triadaspirin sensitivity, asthma, nasal polyps
acid/base process with aspirin toxicityrespiratory alkalosis (increased RR, medulla respiratory center stimulated) --> metabolic acidosis (increased lactic acid) --> respiratory acidosis (decreased mental status and decreased RR)
4 most common symptoms of whipple diseasearthralgia, weight loss, diarrhea, abdominal pain
watery diarrhea, flushing, hypokalemiaVIPoma
lethargy, syncope, diplopia during fasting, improved with foodinsulinoma
insulinoma labslow glucose, high insulin, high C peptide, high proinsulin
surreptitious insulin labslow glucose, high insulin, low C peptide, low proinsulin
diarrhea, anorexia, DM, necrolytic migratory erythemaglucagonoma
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IBD

Question Answer
rectal involvementUC
diffuseUC
pseudopolypsUC
lead pipe appearanceUC
retrograde from rectumUC
circumferentialUC
superficial inflammation of mucosa and submucosaUC
crypt abscess (with neutrophils)UC
Th2 responseUC
toxic megacolonmore often UC, but can be both
associated with PSCUC
bloody diarrheaUC
P-ANCA positiveUC
gets better with smokingUC
related to MHC genesUC
autoimmune processUC
higher genetic susceptibilityCD
skip lesionsCD
rectal sparingCD
transmural inflammationCD
fistulasCD
creeping fatCD
cobble-stone mucosaCD
string signCD
cookie cutter ulcers on barium swallowCD
noncaseating granulomasCD
Th1 responseCD
perianal infectionCD
apthous ulcersCD more but both
increased risk of small bowel adenomaCD
increased risk of CRCboth
migratory polyarthritisCD
worse with smokingCD
better with appendectomyUC
more common with refined carb dietCD
more common with hypersantitationCD
more nutritional problemsCD bc can affect terminal ileum
related to NOD2 genesCD
pyoderma gangrenosumboth (more in UC)
erythema nodosumboth (more in crohns)
ankylosing spondylitisboth
uveitisboth
crypt abscess and cryptitisboth
feces in urine?colovesicular fistula from CD
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3

Question Answer
"olive mass"congenital pyloric stenosis
non bilious projectile vomiting 2-6 wks oldcongenital pyloric stenosis
hematemesisupper GI bleed
melenaupper GI bleed
melanomesislower GI bleed
hematochezialower GI bleed
upper GI bleed causespeptic ulcer disease, esophageal varies, mallory weiss tears
lower GI beed causesdiverticulosis, angiodyplasia, hemorrhoids, colorectal cancer
where is ligament of treitz?4th part of duodenum. This is where lower GI bleeds vs upper Gi bleeds divide
high amylase in what disease?bulimia
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4

Question Answer
how does sjogrens affect a fetus?IgG antibodies cross placenta and can cause AV block
what parts of the esophagus does scleroderma affect?middle 1/3 and lower 1/3 (only smooth muscle layers)
upper esophagus?skeletal muscle
middle esophagus?both skeletal and smooth muscle
lower esophagus?smooth muscle
what muscle is weak in zenker diverticulum?cricopharyngeal muscle
what is the esophagus missing?serosal layer (adventitia)
maternal erythromycin use?pyloric stenosis
treatment of pyloric stenosispyloromyotomy
what happens to pylorus in vagotomy?weakened --> gastric dumping syndrome
most common ulcer location?distal lesser curvature
brunner gland hypertrophyduodenal ulcers
jejunal ulcer?Z-E syndrome! any weird ulcer locations or lots of ulcers is probably ZE
no change in gastrin levels after eating?Z-E syndrome gastrinoma (differentiated from G-cell hyperplasia where serum gastrin levels increase after meal test)
which ulcer type has a higher risk for adenocarcinoma?gastric ulcers
which ulcer type has a higher risk of perforation?duodenal ulcers
decreased stool pHlactose intolerance
increased stool osmotic gaplactose intolerance
high pitched bowel sounds and history of lots of pukingsmall bowel obstruction
colon cancer that causes bleeding/anemiaR sided (cecum)
colon cancer that causes obstruction/change in stool caliberL sided (sigmoid)
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5

Question Answer
air in the biliary tree?gallstone ileus (lodged in ileocecal valve due to fistula from cystic duct to duodenum)
sudden weight loss?SMA syndrome usually bc of a radical diet--> lose fat around SMA --> SMA shifts position to compress the transverse duodenum
most common site for intussusception?ileocecal valve area (where peyer's patches are)
4 causes of bilious vomiting in neonate?malrotation of midgut with volvulus, Intestinal atresia, meconium ileum, hirschsprung disease
intestinal atresia mechanism?failure to recanalize the intestinal lumen
associated with down's syndromeduodenal atresia, hirschprung disease
Hirschsprung mechanismfailure of neural crest cell migration to colon
main site of aganglionosis in hirschprung?rectum
D-xylose test?to differentiate small bowel disease from elsewhere. If you do find D-xylose in blood, then you are absorbing it and it is NOT a small bowel problem. If not, then it is a small bowel problem.
pee out of belly buttonpersistent allantois (urachal remnant)
poo out of belly buttonpersistent vitelline duct (meckels)
GI bleeding in a young child?meckels diverticulum (ileum)
splenic flecture watershed area?between middle colic of SMA and left colic of IMA
most common site for polypssigmoid
turcot's syndromeFAP + brain tumors
gardner's syndromeFAP + bone tumors and soft tissue tumors
peutz-jegerssmall bowel polyps, hamartomas, pigmented mouth, hands and genitals, risk of GI cancer
L sided colon cancerobstructs
R sided colon cancerbleeds
apple-core lesioncolorectal cancer
best way to tell iron deficiency anemia?low ferritin levels
bird beak sign from the bottom up?volvulus
hypovolemia that causes ischemia?ischemic colitis
atherosclerosis caused ischemia?mesenteric ischemia
premature infant with GI problem?necrotizing enterocolitis
painful hemorrhoidsexternal (below pectinate line--> anal) bc somatic innervation from inferior rectal nerves)
painless hemorrhoidsinternal (above pectinate line --> rectal) bc visceral innervation from inferior hypogastric plexus)
cancer above the pectinate lineadenocarcinoma (rectal cancer)
cancer below the pectinate linesquamous cell carcinoma (anal carcinoma)
colon cancer mets?usually to liver
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DRUGS

Question Answer
treatment for gastroparesis?metoclopramide (D2 blocker) AVOID IN PD
aluminum hydroxide tox?constipation
magnesium hydroxide tox?diarrhea
H2 blocker tox?inhibits p450, gynecomastia, increased creatinine
PPI tox?atrophic gastritis due to acid suppression and hypergastrinemia
misoprostolPGE analog that stimulates mucus production useful for ulcers due to NSAID abuse
what should you do before giving misoprostol to a woman?pregnancy test bc it is an abortifacent
sucrulfateselectively binds to necrotic ulcer tissue and protect it from further injury in acidic pH
special about sucrulfate?CANNOT be used with any drugs that lower stomach acid ( H2 blockers and PPIs)
triple therapyclarithromycin, omeprazole, amoxicillin
infliximabmonoclonal antibody to TNF alpha for IBD
sulfasalazineantibacterial and anti-inflammatory med for IBD
toxicity of infliximab?signs of sepsis (feet, chills, hypotension)
contraindication for infliximab?previous TB bc activates underlying infection
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