GI Disorders

What features are seen with Zenker diverticulum?

Dysphagia, regurgitation of undigested food, halitosis, and a sensation of a lump in the throat due to the formation of a pouch in the esophagus.

What causes Zenker diverticulum?

Abnormal spasm or diminished relaxation of cricopharyngeal muscles leading to increased pressure and subsequent outpouching of the esophageal wall.

Small bowel obstruction typically presents with 

progressive abdominal pain, nausea/vomiting, high-pitched bowel sounds on examination, and distended loops of bowel

What causes small bowel obstruction?

adhesions, femoral hernias, tumors, or strictures that block the intestinal lumen.

Nonalcoholic fatty liver disease is characterized by 

the accumulation of fat in the liver without significant alcohol consumption, often associated with obesity, diabetes, and metabolic syndrome.

What will be seen with esophageal spasm?

intermittent chest pain, dysphagia, and abnormal contractions on manometry.

What is the preferred treatment for esophageal spasm?

The preferred treatment includes medications such as calcium channel blockers or nitrates, and in some cases, esophageal dilation may be considered.

What will be seen with Gilbert syndrome?

mildly elevated indirect bilirubin levels, often without other symptoms.

What conditions increase the risk of developing colorectal adenocarcinoma?

Obesity and type 2 diabetes, along with family history of colorectal cancer, inflammatory bowel disease, and certain genetic syndromes.

What will be seen with anorectal fistula?

Symptoms include pain with defecation, swelling, and chronic drainage near the anus, often with recurrent infections. It may also be associated with anal fissures or abscesses.

Why will patients with celiac disease sometimes show negative IgA antibodies?

They may have IgA deficiency, which is common in celiac disease. This deficiency can lead to false-negative results in serological testing.

What is proctalgia fugax?

A condition characterized by sudden, severe anal pain that occurs without any obvious cause and typically resolves quickly.

What are the signs and symptoms of hepatitis A?

Signs and symptoms include fever, fatigue, nausea, abdominal pain, loss of appetite, and jaundice. They typically appear 2 to 6 weeks after exposure to the virus. Will also see extremely elevated liver enzymes

What is the best treatment for diabetic gastroparesis and why?

The best treatment for diabetic gastroparesis is dietary management and medications like prokinetics like metaclopromide. This approach helps improve gastric emptying and alleviate symptoms.

What is the best imaging diagnostic test for cholestasis?

The best imaging diagnostic test for cholestasis is an abdominal ultrasound, as it can help identify bile duct obstructions and assess liver structure.

What will be seen with esophageal stricture?

Concentric, symmetric narrowing of the distal esophagus.

What should be done when there’s bleeding with defecation but no other symptoms?

You should do anoscopy

What are the signs and symptoms of biliary colic?

Severe, intermittent pain in the right upper quadrant, often radiating to the back or shoulder, along with nausea and vomiting.

What will be seen with pill esophagitis?

Patients experience sudden-onset odynophagia and retrosternal pain that can sometimes cause difficulty swallowing.

What medications can cause pill esophagitis?

Common medications include doxycycline, potassium chloride, bisphosphonates, iron supplements, and nonsteroidal anti-inflammatory drugs (NSAIDs). These can irritate the esophagus if not taken with sufficient water.

What will be seen with autoimmune hepatitis?

Patients may present with fatigue, jaundice, abdominal pain, and elevated liver enzymes. Symptoms can also include joint pain and other systemic issues. Total protein - albumin ≥ 4

What are presenting signs for hepatocellular carcinoma?

Patients may present with weight loss, loss of appetite, abdominal pain, and jaundice. Other signs can include an enlarged liver, ascites, elevated alpha-fetoprotein levels, and a liver nodule

Weight loss and fatigue with multiple liver lesions on CT scan suggests

metastatic disease to the liver rather than primary liver cancer.

What are the manifestations for zinc deficiency?

Growth retardation, hair loss, diarrhea, delayed wound healing, and immune dysfunction. Symptoms may also include taste abnormalities and skin lesions.

What will be seen on colonoscopy for radiation proctitis?

Findings may include mucosal inflammation, ulceration, and telangiectasia. These changes are due to damage from radiation therapy and can lead to bleeding.

What is used to treat esophageal varices?

Treatment typically involves the use of beta-blockers, endoscopic band ligation, and in some cases, transjugular intrahepatic portosystemic shunt (TIPS) placement to reduce portal hypertension and prevent bleeding.

What distinguishes peptic ulcers from duodenal ulcers?

With duodenal ulcers, pain often occurs 2-3 hours after eating and is relieved by food, while peptic ulcers may cause pain that occurs shortly after meals.

What is the best treatment for duodenal ulcers?

The best treatment typically includes proton pump inhibitors (PPIs) to reduce stomach acid, along with antibiotics if H. pylori infection is present.

What antibiotics are given to treat H. pylori infection?

Clarithromycin and amoxicillin/metronidazole if penicillin allergic

Diarrhea that is not explained after extensive evaluation suggests

possible factitious diarrhea

How does stool osmolality help determine factitious diarrhea?

Low stool osmolality (<250 mOsm/kg) suggests stool dilution or tampering

What is erythema nodosum and what is it associated with?

Erythema nodosum is a painful inflammatory condition characterized by red, tender nodules, usually occurring on the shins. It is often associated with infections, inflammatory diseases like IBD, and certain medications.

What ascitic fluid tests are ordered after paracentesis?

Tests for cell count, protein, and culture to evaluate for infection or malignancy.

What signs and symptoms are present in upper GI bleed?

Signs include hematemesis, melena, and signs of shock; symptoms may include abdominal pain and weakness.

What should be done for someone with upper GI bleed and has low hemoglobin (<7 or <9)?

Transfusion of red blood cells and stabilization of the patient.

What is the triad for acute cholangitis?

Fever, jaundice, and RUQ abdominal pain.

With acute cholangitis, what will be seen on imaging?

Dilated bile ducts and possible stone obstruction.

What other signs are present with acute cholangitis?

Possible signs include tachycardia, hypotension, and altered mental status with leukocytosis and elevated liver enzymes.

What reproductive issues can cirrhosis lead to?

Cirrhosis can lead to infertility, menstrual irregularities, and hormonal imbalances due to liver dysfunction; gynecomastia and small/firm testes

What are findings of Crohn’s disease?

Transmural inflammation, skip lesions, and strictures in the gastrointestinal tract.

What is a complication of gastric bypass surgery?

Narrowing of the gastric pouch or anastomosis, leading to obstruction.

When someone with gastric bypass surgery comes in with vomiting and reflux, what should be done?

Evaluate for possible obstruction or stricture through EGD

What liver disease can septic shock lead to?

Acute liver failure due to ischemia or hypoperfusion.

What are signs of gastric cancer?

Weight loss, abdominal pain, early satiety, and changes in bowel habits; will also see iron deficiency anemia

What is required to diagnose acute liver failure?

A combination of clinical history, laboratory tests showing elevated liver enzymes, and signs of hepatic encephalopathy.

When someone is vomiting blood because of esophageal varices, what should be given?

Intravenous fluids and vasoactive drugs such as octreotide to reduce portal hypertension.

In cirrhosis, how are spider angiomas and palmar erythema related?

Both are signs of increased estrogen levels due to liver dysfunction, commonly seen in cirrhosis.

In someone who is abusing laxatives, what will colonoscopy show?

Colonoscopy may show colonic atony, mucosal damage (dark brown mucosal pigmentation), or electrolyte imbalances.

What are features of spontaneous bacterial peritonitis?

Fever, abdominal pain, altered mental status, and ascitic fluid infection.

If someone was found to have a solitary lesion on the liver, what is the best thing to do?

Surgical resection of the affected lobe

What antibiotic is used for C. difficile infection?

Oral vancomycin

What do liver enzymes show in alcohol induced pancreatitis?

Lipase more than 3x the upper limit, AST/ALT > 1

What should be done for someone with signs of peritonitis?

Immediate surgical evaluation and intervention may be necessary to address the underlying cause.

What causes cholecystitis?

Cholecystitis is typically caused by gallstones blocking the cystic duct, leading to inflammation of the gallbladder.

What is medical management for small bowel obstruction?

Medical management for small bowel obstruction typically includes bowel rest, IV fluid resuscitation, and NG tube.

What features are seen with anal SCC?

Anal pain, bleeding, and a mass or ulceration in the anal region. It may also show features like lymphadenopathy or changes in bowel habits.

If history is unclear for suspecting appendicitis, what imaging test will confirm it?

A CT scan of the abdomen and pelvis is the preferred imaging test

What is the cutoff for SAAG to determine whether there is transudate or exudate?

The cutoff for Serum-Ascites Albumin Gradient (SAAG) is 1.1 g/dL; values above indicate transudate, while values below suggest exudate.

If SAAG was found to be transudative but low protein in ascitic fluid, what is going on?

This suggests a condition like cirrhosis, where portal hypertension leads to fluid accumulation without significant protein content.

If SAAG was found to be above 1.1, but the protein content is above 2.5 in the ascitic fluid, what is going on?

congestive heart failure, constrictive pericarditis, Budd-Chiari syndrome

If SAAG shows to be exudative, and protein is low, what is going on?

Nephrotic syndrome due to protein loss

If SAAG is shown to be exudative but high protein content, what is going on?

TB or peritoneal carcinoma

What study should all patients with cirrhosis undergo?

A screening for esophageal varices through upper GI endoscopy to assess the risk of bleeding.

What is the main characteristic of focal nodular hyperplasia of the liver?

It is a benign liver lesion characterized by a central scar and hyperplastic hepatocytes.

When would ECRP need to be done?

ERCP may be indicated for diagnosing or treating bile duct obstructions, pancreatitis, or cholangitis.

What are medications which can induce pancreatitis?

Certain medications such as corticosteroids, diuretics like HCTZ and furosemide, and some antibiotics like metronidazole and tetracycline.

What are features of carcinoid syndrome?

Flushing, diarrhea, and wheezing, often due to serotonin secretion from neuroendocrine tumors. It may also lead to tricuspid valve lesions and niacin deficiency.

What complications can result from primary biliary cholangitis?

Complications of primary biliary cholangitis include cirrhosis, liver failure, osteoporosis, and an increased risk of hepatocellular carcinoma.

What does stool guaiac test measure?

The presence of hidden (occult) blood in the stool, which can indicate gastrointestinal bleeding or other underlying conditions like peptic ulcer perforation

What will be seen when peptic ulcers perforate?

Free air under the diaphragm, peritonitis, and diffuse acute abdominal pain in epigastric region due to inflammation and irritation of the peritoneum.

How do you measure SAAG?

The Serum-Ascites Albumin Gradient (SAAG) is measured by calculating the difference between serum albumin and ascitic fluid albumin levels. A SAAG of 1.1 g/dL or greater indicates portal hypertension.

What will paracentesis show with chronic pancreatitis?

It may show elevated levels of amylase and lipase in the ascitic fluid, indicating pancreatic inflammation or damage. The fluid will also be serosanguinous

If there is colonic pseudo obstruction, what is the reason for it?

It is caused by the loss of normal peristalsis in the colon, often due to nerve or muscle dysfunction, leading to bowel distension and obstruction without a physical blockage, such as in conditions like electrolyte imbalances or certain medications like anticholinergics

How can you remember what cancers are at higher risk for Lynch syndrome?

"CEO of Lynch Inc." This mnemonic emphasizes the primary cancers: colorectal, endometrial, and ovarian

What antibodies are seen with lupus?

Antinuclear antibodies (ANA) are commonly seen in lupus, along with anti-double-stranded DNA and anti-Smith antibodies.

How can lupus affect the spleen?

Lupus can cause splenomegaly, increased risk of infections due to splenic dysfunction, and can lead to autoimmune hemolytic anemia. It is also a thrombotic state, causing splenic infarction

If an asymptomatic patient is found to have more AST than ALT, what should that be concerning for?

Possible liver disease, particularly alcoholic liver disease or non-alcoholic fatty liver disease.

If a pancreatic cyst has thickened walls and greater than 4 cm, what is the procedure which needs to be done?

Endoscopic ultrasound-guided FNA to assess for malignancy.

What is the main cause of MALT lymphoma in the stomach?

Chronic infection with Helicobacter pylori.

What is the main reason for painless GI bleed?

Diverticular disease or angiodysplasia.

During acute Hepatitis B infection, which markers will be the highest?

Hepatitis B surface antigen (HBsAg) and IgM anti-HBc.

What are symptoms of IBD?

Abdominal pain, diarrhea (often bloody), weight loss, and fatigue; CRP is also elevated

What is microscopic colitis?

A type of inflammatory bowel disease characterized by chronic, non-bloody diarrhea and normal colonoscopy findings. It includes lymphocytic and collagenous colitis.

What kind of diarrhea is it when stool osmolality gap is high?

Osmotic diarrhea

What kind of diarrhea is it when the stool osmolality gap is low?

Secretory diarrhea

What does chronic giardiasis look like?

Prolonged diarrhea, abdominal pain, bloating, and weight loss. It may lead to malabsorption and nutritional deficiencies.

What causes stress-induced ulcers?

Physiological stressors such as severe illness, surgery, or trauma, which increase gastric acid secretion and reduce mucosal defense.

What will be increased in patients with upper GI bleed?

Gastric acid secretion and urea levels.

What appears on colonoscopy for mesenteric ischemia?

Pale mucosa and ulcerations, hemorrhagic and cyanotic patch alternations

What helps to establish the diagnosis of chronic pancreatitis?

CT scan

Along with AST and ALT, what else will be elevated with alcoholic hepatitis?

GGT and ferritin

How could you think about acetaminophen induced liver injury?

It has the severe AST/ALT elevations like hepatitis but it’s more acute in onset

How does the D-xylose test help diagnose malabsorption?

If D-xylose absorption is normal, but the patient still has malabsorption symptoms, the issue may be due to pancreatic insufficiency (e.g., chronic pancreatitis, cystic fibrosis), where digestive enzymes are lacking.

On the other hand, low levels of D-xylose in blood or urine suggest malabsorption due to small bowel diseases (e.g., celiac disease, bacterial overgrowth, Whipple’s disease).

What will a retrocardiac air-fluid level suggest?

Paraesophageal hiatal hernia, which occurs when part of the stomach pushes through the diaphragm beside the esophagus.

What is the procedure for diagnosing primary sclerosing cholangitis?

The procedure typically involves imaging studies such as magnetic resonance cholangiopancreatography (MRCP) to visualize the bile ducts and assess for strictures or dilation, alongside liver function tests and sometimes liver biopsy.

When someone is having alcohol-associated liver disease, what is the best intervention to decrease inflammation and portal pressure?

The best intervention is to abstain from alcohol, which helps reduce liver inflammation and portal hypertension. Additionally, medications such as corticosteroids may be used to manage inflammation.

If furosemide is given for ascites, should you also give spironolactone as well?

Yes, combining furosemide with spironolactone can help reduce ascites effectively by promoting diuresis while minimizing potassium loss.

If cholesterol emboli is the cause of pancreatitis, what should be the treatment?

The treatment focuses on managing the underlying cause, which may include supportive care, pain management, and addressing any complications. In some cases, interventions to reduce cholesterol levels or surgical options may be considered.

If a patient has new-onset constipation with occasional bloody stool and anemia, what should be done?

A thorough evaluation is necessary to rule out serious conditions such as colorectal cancer. This may include a colonoscopy and other diagnostic tests.

What is seen in hepatorenal syndrome?

Renal failure in patients with advanced liver disease, usually with low urine output and high serum creatinine levels, indicating impaired kidney function.