Gastroenterology Flashcards
What is the differential for an elevated AFP (3)?
- Hepatocellular carcinoma
- Cholangiocarcinoma
- Germ Cell Tumors
Which chronic disease and what malignancy is associated with Primary Sclerosing Cholangitis?
- Ulcerative Colitis (80% of PSC)
2. Cholangiocarcinoma (10%)
- Name two chronic diseases ASSOCIATED with Celiac Disease.
2. Name two malignancies associated with Celiac Disease.
- DM1 and autoimmune thyroditis
2. Enteropathy-associated T-cell lymphoma AND Non-Hodgkin lymphoma
What serologic labs can be checked for Celiac Disease (4)? Which are more sensitive and specific?
- Anti-tissue transglutaminase IgA ab*
- Anti-endomysial IgA ab*
- Anti-tissue transglutaminase IgG ab assays**
- Antigliadin antibody***
- High sensitivity and specificity
- *Low sensitivity and high specificity but some have IgA deficiency, thus measure IgG antibody
- **Not useful in diagnosis, however useful in following dietary response to gluten withdrawal
- What is waterbrash? What does it suggest?
2. What is rumination?
- Salty food taste in mouth - from GERD
2. Effortless regurgitation into mouth
What scenarios would warrant EGD evaluation for GERD (4)?
- Fail to respond to treatment
- Symptoms greater than 5 years
- Older than 50yo
- Alarm symptoms: weight loss, dysphagia, anemia
- There is a long-term anatomical complication from GERD. How would anti-reflux surgery affect this complication?
- What is a nonsurgical option for patients with Barrett’s high grade dysplasia who do not want esophagectomy?
- What is a complication?
- It does NOT alter natural history of Barrett’s
- Endoscopic ablation
- Esophageal strictures
For Gastric Squamous Carcinoma vs. Adenocarcinoma:
- Which races are more affected?
- What are risk factors?
- Where do they arise?
- Blacks………White
- Adenocarcinoma
- Tobacco
- Barrett’s
- GERD
- Obesity
Squamous Cell
- Tobacco - EtOH - Lye
- Adenocarcinoma: Distal
Squamous Cell: Mid-esophagus
- What is the test of choice for Achalasia and how does it appear?
- What are treatment options (4)?
- Barium esophagography –> air-fluid level with “bird’s beak” appearance
- a. Heller myotomy (+ Nissen) - durable
b. Pneumatic dilation
c. Botox - short-term 12 months
d. CCB - last line therapy
- What is the difference between Diffuse Esophageal Spasm and Nutcracker Esophagus?
- How are they diagnosed?
Diffuse Esophageal Spasm - simultaneous esophageal contractions interspersed with normal peristalsis
Nutcracker Esophagus - Very high amplitude peristaltic contractions
**Diagnosed by Esophageal Manometry
- What is the treatment for Candida esophagitis?
- What is the treatment for CMV esophagitis (3)?
- What is the treatment for HSV esophagitis?
- Fluconazole or Itraconazole
- Ganciclovir, Foscarnet, Cidofovir or Acyclovir
- Famciclovir or Acyclovir –> Foscarnet
What drugs are implicated with Pill Esophagitis (6)?
- Tetracycline
- Iron Sulfate
- Bisphosphonates
- Potassium
- NSAIDs
- Quinidine
- What symptom is provided with Eosinophilic Esophagitis?
- What medical history is provided (2)?
- What appears on EGD (4)?
- What is treatment (4)?
- Intermittent dysphagia without odynophagia
- Food allergies and asthma
- a. Multiple concentric rings
b. Diffuse multiple white specks
c. Friable mucosa
d. Linear tearing of esophagus - a. Elimination of food allergens
b. TRIAL OF PPI - FIRST R/O GERD
c. Topical steroids - first-line
d. Leukotriene antagonists - second-line
- What happens with food with a duodenal ulcer?
2. What happens with food with a gastric ulcer?
- Improves - pyloric sphincter closes
2. Worsens - gastric acid secretion
- In terms of peptic ulcers, what is penetration?
2. What are common sites of penetration?
- Penetration = peptic ulcer tunneling into adjacent organs
- a. Duodenal ulcers –> pancreas
b. Gastric ulcers –> left hepatic lobe
- How do you screen for Zollinger-Ellison syndrome?
- What is the associated syndrome?
- Which Zollinger-Ellison syndrome is more likely to metastasize?
- ZE = gastrinoma thus serum gastrin (>1,000) or HYPERCHLORHYDRIA
- MEN1
- Sporadic metastases, not MEN1
What is the surgical management for refractory peptic ulcer disease (2)?
- Antrectomy and Vagotomy via:
a. Billroth I: gastroDUODENOstomy
b. Billrott II: gastroJEJUNOstomy
Which patients are at risk for NSAID-induced ulcers (5)?
- History of peptic ulcer
- Concomitant use of steroids or anticoagulants
- Age greater than 75
- High-dose NSAIDs or NSAIDS + Aspirin
- COX2 + Aspirin
What are treatment options for prevention of NSAID-induced ulcers (3)? What are their caveats?
- PPI - first line
- Famotidine (high-dose, not other H2B)
- Misoprostol - prostaglandin analog, ++diarrhea
Following gastric adenoma surgical resection, what chemotherapeutic agents are used (2)?
- 5-Fluorouracil
2. Leucovorin
What are medication treatment for gastroparesis (4)?
- Erythromycin
- Metoclopramide
- Tegaserod - FDA-approval, 5HT4 agonist
- Domperidone (not U.S.)
What is a possible long-term complication for a afferent loop surgery (i.e. Billroth II)? What are two symptoms?
Bacterial overgrowth
a. Postprandial pain b. Diarrhea with malabsorption of fats and B12
- What is Dumping Syndrome?
2. Describe the two phases.
- Rapid emptying of gastric contents after meals, especially after simple carbohydrates (i.e. sucrose)
- Early 15-30m after meals:
a. abdominal cramps
b. nausea
c. osmolar diarrhea
Late 90m-3h after meals
a. hypoglyemia
If gallstones are not seen on CT, what are other imaging modalities?
- EUS
2. MRCP
What variables suggest poor prognosis following an acute pancreatitis (4)?
- BMI greater than 25
- Hct greater than 50
- High ESR/CRP
- Rising BUN
What cancers are attributable to MEN1?
MEN1 = three Ps
- Pancreas (gastrin, insulin, VIPoma) - Pituitary (prolactin) - Parathyroid
What cancers are attributable to MEN2?
MEN2
- Medullary thyroid carcinoma - Pheochromocytoma - Parathyroid
What cancers are attributable to MEN3?
MEN3
- Medullary thyroid carcinoma - Pheochromocytoma - mucosal neuroma (ganglioneuromatosis)
- For patients with cirrhosis and HCC, what are indications for transplant (3)?
- When patients with large HCC tumors are not candidates for transplant, what is a treatment option?
- How about small tumors?
- a. 3 or fewer lesions less than 3 cm
b. 1 lesion less than 5 cm
c. Cirrhosis with poor liver reserve - Periodic transarterial chemoembolization
- Percutaneous ablative alcohol injection or radiofrequency ablation
What are relative contraindications for hepatic resection in the setting of HCC (3)?
- Underlying cirrhosis
- Portal HTN
- Hepatic dysfunction
What is another name for a gastric emptying study?
Gastric scintigraphy
- What are two serologic tests that suggest hemochromatosis?
- What is the diagnostic test?
- What is treatment if phlebotomy is not tolerated?
- a. Elevated Transferrin (especially >55% men and >50% women)
b. Elevated Ferritin - HFE gene
- Deferoxamine an iron chelator
What differentiates secretory from osmotic diarrhea?
Stool electrolytes and osmotic gap (normal 290):
- 290 MINUS 2 x (Na + K) - Secretory < 50 - Osmotic >=125
Define acute and chronic diarrhea
Acute diarrhea < 2 weeks
Chronic diarrhea > 4 weeks
With a fecal fat test, what is the threshold for __?
Fecal fat > 14g / 24 hours = Malabsorption
- What is normal stool osmolarity?
2. What value suggest factitious?
- Normal = 280-300
2. Less than 250 suggests factitious
What part in a patient’s description of stool suggests malabsorption?
Oily stool