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MKSAP - Internal > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

gold standard for dx. kidney stones in someone who presents with unilateral flank pain

A

non-contrast helical CT scan

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2
Q

acute abdomen

A

sudden and severe abdominal pain less than 24 hours in duration

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3
Q

next best step in pt presenting with acute abdomen

A

chest XR

supine and upright abdominal radiographs - to exclude bowel obstruction or perforation

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4
Q

what is definitive diagnostic test for acute abdominal pain?

A

abdominal CT scan

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5
Q

elderly man presents with severe back pain with syncope followed by abdominal discomfort - dx?

A

ruptured aortic aneurysm

- medical emergency

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6
Q

what diagnostic test should be performed in someone suspected of having ruptured aortic aneurysm

A

CT scan followed by surgery

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7
Q

patient presents with fever, crampy abdominal pain (LLQ) and an associated change in bowel habits; labs show leukocytosis - dx?

A

diverticulitis

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8
Q

Rome III criteria

A

atleast two of:

  • pain releived with defecation
  • onset assoc. w/ change in stool frequency
  • onset assoc. w/ change in consistency of stool
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9
Q

alarm symptoms

A 
older age
male sex
nocturnal awakening
rectal bleeding
weight loss
family history of colon cancer
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10
Q

tx. of constipation-predom IBS in a pt whom fibre supplements did not work

A

reassurance and polyethylene glycol

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11
Q

an elderly patient with known atherosclerotic disease presents with rapid onset, severe abdominal pain or tenderness; she also notes bright red rectal bleeding and diarrhea - what test should you do? what will you find? and what is diagnosis?

A

do CT scan abdomen

dx. ischemic colitis
- will show segmental thickening of bowel wall

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12
Q

how do you establish diagnosis of ischemic colitis?

A

colonscopy - patchy segmental ulcerations (in pt with compatible history)

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13
Q

patient presents with signs/symptoms of acute diverticulitis - what imaging/diagnostic test should you do?

A

contrast-enhanced CT scan of abdomen and pelvis

- confirms diagnosis as well as evaluates for any complications

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14
Q

what two tests should be avoided in suspected acute diverticulitis?

A

colonscopy
barium enema
- both pose risk of perforation with air insufflation

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15
Q

complications of diverticulitis

A

obstruction
perforation
abscess
fistulas

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16
Q

chronic alcoholic patient presents with chronic upper abdominal pain radiating to the back, diabetes and steatorrhea - what do you consider?

A

chronic pancreatitis

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17
Q

how do you confirm dx of chronic pancreatitis?

A

calcififcations on plain films or CT scan

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18
Q

patient presents with pain, fever and jaundice; there is also elevation of pancreatic enzymes in the setting of biliary obstruction…

A

acute cholangitis

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19
Q

diagnostic criteria of HUS

A

thrombocytopenia

microangiopathic hemolytic anemia (schistocytes, elevated reticulocytes, elevated LDH)

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20
Q

tx. of HUS

A

supportive with fluids and monitoring of electrolytes and blood counts

  • packed RBC is anemia is severe
  • antibiotics and platelets are not recommeneded
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21
Q

patient presents with diarrhea and tenesmus; she recently underwent chemotherapy and radiation for rectal cancer - dx?

A

radiation proctitis

- develops within 6 weeks after tx and resolves on its own usually

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22
Q

how do you diagnose radiation proctitis?

A

flexible sigmoidoscopy

  • mucosal telengiectasias
  • submucosal fibrosis
  • arteriole endarteritis
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23
Q

when does stool osmolality test come in handy?

A

when you want to distinguish osmotic diarrhea from secretory diarrhea - ie. in pts having factitious diarrhea (low stool osmolality)

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24
Q

how does malabsorption present in chronic pancreatitis?

A

diarrhea, steatorrhea
weight loss
deficiency in fat soluble vitamins

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25
Q

definitive diagnostic test for chronic pancreatitis

A

abdominal CT scan

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26
Q

tx. of severe CDI with colitis

A

oral vancomycin

IV metronidazole

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27
Q

Tx. of ischemic colitis

A

IV fluids and bowel rest

- symptoms resolve w/in 48 hrs

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28
Q

what patients with salmonella gastroenteritis should receive antibiotic therapy?

A
  1. pts < 2y yo or > 50 yo
  2. pts with severe illness - toxicity/bacteremia
  3. pts with atherosclerotic plaques, endovascular or bone prosthesis - seeding
  4. immunocompromised pts
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29
Q

what drugs should be avoided in pts with infectious diarrhea (fever, bloody stools, systemic toxicity)

A

bowel paralytics such as loperamide

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30
Q

how do you diagnose hepatocellular injury?

A

elevation of ALT (more specific )and AST

direct (CB) hyperbilirubinemia > 50%

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31
Q

how do you diagnose cholestatic injury?

A

elevation of ALP (minimal elevations of ALT and AST)

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32
Q

first step to evaluate cholestatic pattern of injury?

A

USG - determine if intrahepatic or extrahepatic biliary obstruction is present

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33
Q

how do you diagnose non-hepatic injury such as muscle injury?

A

striking elevations of AST (less ALT)

no assoc. elevation of CB

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34
Q

incidental finding of indirect (UCB) hyperbilirubinemia in an asymptomatic patient, with normal Hb and LFTs - dx?

A

Gilbert’s syndrome

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35
Q

Gilbert’s syndrome

A

total bilirubin conc. up to 3.0 mg/dL resulting from a reduced expression of enzyme that conjugates bilirubin

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36
Q

lab findings in pts with hemolysis

A

UCB high

low Hb level, low MCV and high RDW

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37
Q

cholestatic dz due to OCP

A

CB high

elevated ALP

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38
Q

ERCP with sphincerterectomy is recommended for…

A

pts with biliary obstruction due to choledocholithiasis

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39
Q

definitive tx. for pts with symptomatic gallstone disease

A

laparoscopic cholecystectomy

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40
Q

chronic cholestatic disease, associated with IBD, characterized by fibrosis, inflammation and stricturing of the biliary tree

A

primary sclerosing cholangitis

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41
Q

dx. of primary sclerosing cholangitis

A

elevated ALP

dx. ERCP - take biopsy, place stent if needed

42
Q

patient presents with history of pain that radiates to right shoulder, Murphy sign, fever, leukocytosis, mild elevation in LFTs - what diagnostic test should you do?

A

USG - to dx. acute cholecystitis: will reveal gallstones, pericholecystic fluid and thickened gallbladder wall

43
Q

patient presents with fever, jaundice and RUQ pain; on USG there is bile duct dilation and gallstones in gallbladder - dx?

A

acute cholangitis

44
Q

Tx. of acute cholangitis

A

broad spectrum empiric antibiotics

ERCP with sphincterectomy to remove impacted stones

45
Q

how do you confirm diagnosis of acute pancreatitis?

A

serum conc. of amylase and lipase at least 3x the upper limit of normal

46
Q

next steps in someone with elevated pancreatic enzymes and suspected acute pancreatitis?

A

abdominal USG - to detect cholelithiasis

ERCP - pts with evidence of gallstone pancreatitis and suspected biliary obstruction

47
Q

preferred immediate intervention for removing obstructing stones in acute pancreatitis

A

ERCP w/ spincterectomy and stone extraction

48
Q

preferred route for providing nutrition in patients with severe acute pancreatitis

A

enteral feeding w/ nasojejunal tube

49
Q

tx. of pancreatic necrosis

A

imipenem
- antibiotics should only be used in this case
surgical debridement

50
Q

dx. of pancreatic necrosis

A

contrast enhanced CT scan showing non-enhancing pancreatic tissue

51
Q

pt presents with burning pain releived by antacids and worsened by lying down/bending forward

A

GERD

52
Q

how do you diagnose and confirm GERD in pt absent of alarm symptoms?

A

trial of PPI

53
Q

pt with GERD and alarm symptoms, ie. dysphagia - what do you do?

A

upper endoscopy

54
Q

gold standard for dx. GERD

A

ambulatory 24hr pH monitoring

- for pts in whom dx is uncertain or are unresponsive to therapy

55
Q

Tx of choice for erosive esophagitis

A

PPI

56
Q

a pt is found to have a gastric ulcer on endoscopy - what should you do?

A

biopsy!! - even benign appearing ulcers may harbor malignancy

57
Q

test of choice for dx. h.pylori

A

endoscopy with biopsy

58
Q

triple therapy for h.pylori

A

PPI
amoxicillin
clarithromycin

59
Q

2 MCC of peptic ulcer disease

A

NSAIDs

h.pylori

60
Q

pt presents with multiple ulcers in unusual locations, severe esophagitis and fat malabsorption - dx?

A

Zollinger-Ellison

- measure serum gastrin to confirm

61
Q

indications for upper endscopy in evaluation of dyspepsia

A
  • pt > 55 yo w new onset dyspepsia

- alarm symptoms

62
Q

functional dyspepsia

A

chronic or recurrent discomfort in epigastrium w. no organic cause determined

63
Q

recommended tx. for functional dyspepsia

A

do a trial of PPI

64
Q

most accurate method of confirming GERD

A

ambulatory pH monitoring for 24 hrs

- do if dx is uncertain or GERD therapy is unsuccessful

65
Q

Cameron lesions

A

linear gastric ulcers or erosions in a hiatal hernia sac - usually incidental findings but may cause chronic or acute blood loss

66
Q

what do you do next in someone who had a non-diagnostic Upper EGD and lower endoscopy but it still bleeding?

A

repeat upper EGD or wireless capsule endoscpy

67
Q

indications for double balloon endoscopy

A
  • evaluate/tx findings on capsule endoscopy
  • evaluation of ongoing bleeding with endoscopic hemostasis needed
  • nondiagnostic wireless capsule endoscopy
68
Q

male, 60 yo, presents with LLQ pain, urgent defecation and red/marroon rectal bleeding; colonscopy shows segmental and hemorrhagic nodules and possible gangrene- dx?

A

ischemic colitis

69
Q

therapy of ischemic colitis

A

IVF

antibiotics - to cover anaerobes and gram neg bacteria

70
Q

pt presents with abdominal pain out of proportion to the P/E findings; occult (not overt) blood is present

A

acute mesenteric ischemia

71
Q

important cause of massive painless lower GI Bleeding in older patients

A

diverticulosis

72
Q

pt presents with LLQ pain, fever, leukocytosis; not overt rectal bleeding is seen - dx? what test should you avoid?

A

diverticulitis

- avoid colonscopy for risk of perforation

73
Q

first management of choice for upper GI Bleeding

A

endoscopic intervention

74
Q

what drug has been shown to reduce the risk of recurrent upper GI bleeding in peptic ulcers after endoscopic hemostasis?

A

IV omeprazole

75
Q

when is arteriography useful in management of upper GI Bleeds?

A

pts with presume arterial bleed as in PUD or tumors of GI tract
- can be used to identify and embolize the vessel

76
Q

next step after IVF resuscitation in acute variceal bleed?

A

EGD with band ligation (sclerotherapy as effective)

77
Q

chronic anal fissures are often accompanied by…

A

skin tags

78
Q

recurrent or nonhealing anal fissures should raise concern for…

A

Crohn’s disease

79
Q

how do you screen for HCC in a pt with chronic hep B or C or alcoholic liver disease/

A

USG

80
Q

how can you diagnose HCC without biopsy?

A

positive ultrasound results

AFP > 500

81
Q

antibodies present in autoimmune hepatitis

A

ANA
anti-sm mm ab’s
anti-LKM1 ab’s

82
Q

screening test to determine exposure to Hep C virus

A

anti-HCV antibody

83
Q

test to determine active Hep C infection

A

HCV RNA test

84
Q

highest risk for acquiring hep D

A

injection drug users with Hep B

85
Q

who is non-alcoholic steatohepatitis most commonly seen in?

A

obesity, insulin resistance, HTN, hyperlipidemia, metabolic syndrome

86
Q

how can you diagnose non-alcoholic steatohepatitis?

A

patients with characteristic clinical risk factors have mildly elevated serum aminotransferase concentrations; imaging confirms steatosis

87
Q

a pt with UC presents with significantly elevated ALP levels; he is experiencing pruritus and fatigue - what should you consider?

A

primary sclerosing cholangitis

- inflammation and fibrosis of intra and extra hepatic bile ducts leading to cirrhosis

88
Q

how can you tell apart PBC and PSC?

A

PBC is associated with presence of other autoimmune conditions and most pts have a positive antimitochondrial ab’s assay

89
Q

serum-to-ascites albumin gradient

A

subtract the ascitic fluid albumin level from the serum albumin level

90
Q

SAAG > 1.1 g/dL

A

indicates portal hypertension -can be due to cirrhosis, RHF or Budd-Chiari syndrome

91
Q

SAAG < 1.1 g/dL

A

no portal HTN; it is associated with other conditions such as infection, inflammation and low serum oncotic pressure

92
Q

inciting events that can precipitate hepatic encepahlopathy in pts with cirrhosis

A 
dehydration - diuretic therapy
infection - peritonitis, UTIs
diet indiscretions
GI bleeding
medications
93
Q

what is the optimal dose of lactulose for tx. of hepatic encephalopathy?

A

titrated to achieve two-three soft stools per day with a pH < 6.0

94
Q

kidney failure in pts with portal HTN and normal renal tubular function

A

hepatorenal syndrome

- must exclude all other causes of renal failure first

95
Q

most effective tx. for hepatorenal syndrome

A

liver transplantation

96
Q

MC cutaneous manifestation of IBD, most common in Crohns

A

erythema nodosum

97
Q

MC cutaneous manifestation of UC

A

pyoderma gangrenosum

98
Q

pyoderma gangrenosum

A

neutrophillic, ulcerative skin disease with multiple lesions on lower extremities; begin as tender papules/pustules that ulcerate leaving a purulent base and ragged, violoceaous borders

99
Q

MC location of rheumatoid nodules

A

subcutaneous tissue just distal to elbow on extensor surface of forearm

100
Q

first line therapy for induction and maintenance of remission in UC

A

mesalamine

101
Q

tx. of microscopic colitis

A

loperamide, diphenoxylate, bismuth subsalicylate

MKSAP - Internal (11 decks)

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