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Board Basics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Barium swallow, EGD, mamometry: Which test do we do first if suspect achalasia?

A

Barium swallow

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2
Q

When do you do an ambulatory esophageal pH monitoring for GERD?

A

After a normal upper endoscopy and have sx refractory to PPIs

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3
Q

Before having antireflux surgery for GERD, what 2 tests should a patient undergo?

A

pH monitoring and manometry

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4
Q

What is the titration of PPI before doing an upper endoscopy for GERD?

A

daily PPI then BID for 4-8 weeks

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5
Q

Who should be screened for Barrett esphagus?

A

men >50 yo with GERD for more than 5 years with additional risk factors like nocturnal reflux sx, hiatal hernia, elevated BMI, tobacco use and intraabdominal distribution of fat

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6
Q

What is the treatment for Barrett esphagus without dysplasia?

With low or high grade dysplasia?

A

PPI

ablation

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7
Q

How frequently do you do surveillance exams for Barrett esophagus without dysplasia? with low grade dysplasia?

A

Without: 3-5 years

Low grade dysplasia: 6-12 months who don’t choose endoscopic ablation

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8
Q

what are the 3 most common infections causing esophagitis?

A

candida albicans, CMV and HSV

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9
Q

What 5 medications cause pill-induced esophagitis?

A

tetracyclines, NSAIDs, potassium chloride, iron, alendronate

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10
Q

what can be seen on upper endoscopy as mucosal furrowing, stacked circular rings, white specks and mucosal friability?

A

eosinophilic esophagitis

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11
Q

What is a mimicker of eosphageal eosinophilia? How can you tell the difference?

A

GERD

8 week trial of PPI, if improvement, then it is GERD associated instead of eiosinophilic

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12
Q

What are the top 2 causes of peptic ulcer disease?

A

H pylori and NSAIDs

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13
Q

What are 4 complications of peptic ulcer disease?

A

penetration, perforation, outlet obstruction, bleeding

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14
Q

How should a patient <60 yo with dyspepsia without alarm symptoms, be tested for H pylori?

A

Do a “test and treat” approach including urea breath test and stool test

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15
Q

How should a patient >60 yo or those with alarm sx be tested for H pylori?

A

upper endoscopy and H pylori testing

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16
Q

T/F: antibiotics, busmuth containing compounds or PPIs can give you a false negative H pylori test

A

T

Wait 28 days for abx, 2 weeks for PPIs

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17
Q

What can be used to treat H pylori if there is clarithromycin resistance?

A

bismuth quadruple therapy

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18
Q

When is follow up upper endoscopy for gastric ulcers performed?

A

if symptomatic after treatment, cause is uncertain or biopsies not performed initially

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19
Q

T/F: Duodenal PUD without complications requires a follow up upper endoscopy

A

F

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20
Q

What therapy should be used in H pylori with patients with a penicillin allergy?

A

Bismuth quadruple therapy

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21
Q

what 4 meds can cause dyspepsia?

A

NSAIDs, abx, bisphosphonates, potassium supplements

22
Q

What should be investigated for if have acute gastroparesis?

A

pyloric channel obstruction with upper endoscopy

23
Q

What is the next step if patient with gastroparesis with chronic symptoms or negative findings on upper endoscopy?

A

nuclear medicine solid-phase gastric emptying study

24
Q

T/F: A low blood glucose can impair gastric emptying

A

F; hyperglycemia over 275 can cause gastric emptying

25
Q

What medication can be used for acute vs chronic gastroparesis?

A

acute: IV erythromycin
chronic: metaclopramide

26
Q

What are 2 serious side effects of metaclopramide?

A

tardic dyskinesia and dystonia

27
Q

What causes loose stools and malabsorption following bypass surgery?

A

blind loop syndrome (SIBO)

tx: abx and nutritional supplements

28
Q

What causes abdominal pain, bloating, difficulty belching after fundoplication?

A

gas-bloat syndrome

tx: diet modification

29
Q

What 8 medications can cause pancreatitis?

A

sulfonamides, estrogens, didanosine, valproic acid, thiazide diuretics, azathioprine/6MP, pentamidine, furosemide

30
Q

What 4 diseases can cause increased amylase besides pancreatitis?

A

kidney disease, intestinal ischemia, appendicitis, parotitis

31
Q

What is the treatment for pancreatic pseudocytsts?

A

usually resolve spontaneously

if sx, then can do transgastric or transduodenal drainage

32
Q

What is the most common cause of chronic pancreatitis?

A

chronic alcohol use

33
Q

What is the next step after calcifications in the pancreas is NOT seen on CT for a patient with suspected chronic pancreatitis?

A

MRI, MRCP or endoscopic US

34
Q

What dx can present with “sausage-shaped” pancreatic enlargement with an indistinct border on cross sectional imaging?

A

autoimmune pancreatitis

35
Q

Which type of autoimmune pancreatiits can be seen in older men, pancreatitis, Sjogren syndrome, PSC, bild duct strictures, autoimmune thyroiditis and interstitial nephritis? What lab value is elevated?

A

type I

IgG4 increased

36
Q

Which type of autoimmune pancreatiitis is associated with chronic pancreatitis and IBD?

A

type II

37
Q

What is the treatment for autoimmune pancreatitis?

A

glucocorticoids

38
Q

Which bacteria can mimic appendicitis or Crohn disease?

A

Yersinia enterocolitica colitis

39
Q

Which diarrheal illness is common in AIDS?

A

cryptosporidiosis

40
Q

What is the treatment for diarrhea caused by giardia lamblia or entamoeba histolytica?

A

flagyl

41
Q

What is the consequence of using loperamide or diphenoxylate for acute diarrhea with EHEC colitis and C diff?

A

EHEC–causes HUS

C diff–causes toxic megacolon

42
Q

What is the most common infectious cause of chronic diarrhea in developed world in immunocompetent patient?

A

giardia lamblia

43
Q

What is the first step in evaluation of chronic diarrhea?

A

colonoscopy

eval for Crohn disease and microscopic colitis

44
Q

What is the next step if colonoscopy is negative in evaluating chronic diarrhea?

A

48-72 hour stool collection with analysis of fat content

fat excretion >14g/d is diagnostic of steatorrhea

45
Q

What is the differential for steatorrhea? (3)

A

small bowel malabsorption disorders, bacterial overgrowth, pancreatic insufficiency

46
Q

What is the formula to calculate osmotic gap?

A

290- (2x(Na+K))

omostic gap of >100=osmotic diarrhea
gap of <50 is secretory diarrhea
measured stool osm <250 means factitious diarrhea

47
Q

What is the most common cause of osmotic diarrhea?

A

lactase deficiency

associated with eating, improves with fasting, not nocturnal

48
Q

What sets osmotic and secretory diarrhea apart?

A

secretory=unchanged by fasting, osm gap<50, nocturnal

49
Q

What is diagnosed in diarrhea in women 45-60yo unreleated to food intake with normal colonoscopy?

A

microscopic colitis, stop NSADs/PPI, biopsy

50
Q

What is diagnosed with coexistent pulm disease and/or recurrent Giardia infection? (2)

A

CVI and selective IgA deficiency

51
Q

Malabsorption

A

132

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