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ABR > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

Intermittent dysphagia to solids and liquids

Chest pain

A

Diffuse esophageal spasm

Barium swallow will show corkscrew esophagus

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2
Q

Management for lower esophageal (Schatzki’s) ring

A

Pneumatic dilatation

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3
Q

Management for achalasia

A

Surgical myotomy

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4
Q

Intervention to R/o psuedoachalasia

A

EGD

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5
Q

Food impaction
Stacked concentric rings
Biopsy reveals +eosinophils

A

Eosinophilic esophagitis

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6
Q 
HIV+
EGD with
1) large ulcer 
2) multiple small ulcers
3) multiple white plaque like lesions
A

1) CMV
2) Herpes
3) candida

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7
Q

Diagnosing esophageal rupture

A

Gastrograffin swallow study

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8
Q

Hypochlorhydria

EGD with striking involvement of gastric folds or rugae

A

Menetrier disease

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9
Q

Treatment for H. Pylori

A

14 days of

PPI, Amoxicillin, Clarithomycin

OR

Metronidazole, Omeprazole, Clarithromycin

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10
Q

Recurrent h. Pylori despite triple therapy

A

Tetracycline
Metronidazole
Bismuth salicylate
PPI

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11
Q

Diagnosing Zollinger-Ellison syndrome

A

Elevated fasting gastric

If not diagnostic, then IV secretin
» increase gastric > 1000

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12
Q

Gastric varies alone

Gastric and esophageal varies

A

Splenic v thrombosis

Cirrhosis

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13
Q

Management for postprandial dumping 15 min after with palpitations, Sweating, low BP

A

High fiber, complex carbs, protein rich foods

Rapid emptying

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14
Q

Management for postprandial dumping/hypotension > 90 min later with palpitations, tachycardia, confusions

A

Frequent small meals, liquid and puréed diet
Complex sugars, low fiber, increased protein

(Hypoglycemia)

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15
Q

Post-gastrectomy with fat and B12 malabsorption

A

Blind loop syndrome with bacterial overgrowth

Deconjugation of bile salts&raquo_space; steatorrhea

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16
Q

Next step in management after stabilizing patient with ascending cholangitis with Abx and IVF

A

ERCP

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17
Q

Management for cholodocolithiasis with dilated CBD

A

ERCP followed by cholecystectomy before discharge

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18
Q

Pancreas with Sausage shaped mass
Elevated IgG4

Management

A

Dx: Autoimmune pancreatitis

Tx: steroids

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19
Q

Recurrent pancreatitis
Ventral duct contents flowing normally to major papilla
Dorsal duct dilated and content flowing through minor papilla sluggishly

A

Pancreas divisum

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20
Q

Most important prognostic factor in acute pancreatitis

A

Increase BUN (>19 = poor prognosis)

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21
Q

Pancreatitis
Muscle spasms
Weakness

A

Hypocalcemia

Due to saponification

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22
Q 
Complications of pancreatitis at
2 days
< 2 weeks
1-4 weeks
4-6 weeks
Anytime
A 
2 days: fluid collections
< 2 wks: pancreatic necrosis 
1-4 wks: pseudocyst
4-6 wks: abscess
Anytime: splenic vein thrombosis
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23
Q

Worrisome features on CT scan for pancreatic cyst

A

Solid
Size > 3 cm
Dilated duct > 10 cm
Thickening of cyst

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24
Q

Pancreatic cyst with 2 worrisome

Features on CT scan

A

EUS-FNA

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25
Pancreatic cyst with EUS-FNA confirming 2 worrisome features, but FNA negative
Resect
26
Pancreatic cyst with EUS-FNA negative for worrisome feature
MRI in 1 year then q 2 years
27
2 cm pancreatic cyst lesion on CT | F/u MRI in 1 year shows size change
EUS-FNA
28
Pancreatic cyst with EUS-FMA showing inflammatory cells and RBCs
Resect
29
Pancreatic cyst resected for malignant lesions
Repeat MRI q 2 years
30
Large pancreatic cyst resected but no evidence of malignancy
No need for f/u after resection
31
Best screening tool for IBD
Fecal calprotectin
32
Extraintestinal manifestations that mirror IBD
Erythema nodosum Peripheral arthritis Pyoderma gangrenosum
33
Extraintestinal manifestations that DO NOT mirror IBD
Sacroiliitis | Primary sclerosing cholangitis
34
Best treatment for stricture in IBD
Surgery
35
Diarrhea RLQ mass Ulcer on tongue
Crohn’s disease
36
Bloody diarrhea | Colonoscopy with erythematous appearance with friable mucosa in distal colon
Ulcerative colitis
37
Diarrheal illnesses that wake patient up at night
IBD Bacterial overgrowth syndrome Dumping syndromes
38
Maintenance medication for IBD
5-ASA (mesalamine)
39
Management for immune checkpoint inhibitors induced side effects (I.e. abdominal pain, diarrhea, rash)
Hold ICI and start steroids
40
Ulcerative colitis Jaundice, hepatomegaly Beading and focal dilatation of biliary tree
Primary sclerosing cholangitis
41
Rectal bleed Tenesmus Anal fissure Leg ulcer
Ulcerative colitis
42
Diarrhea of > 1L per day | Stool osmotic gap < 50
Secretory
43
Diarrhea is < 1L per day | Stool osmotic gap > 50
Osmotic
44
Prophylaxis for travelers diarrhea
Azithromycin
45
Diarrhea Seafood Gram negative, comma-shaped organisms
Vibrio parahrmolyticus
46
Diarrhea | T cell < 100
Cryptosporidium
47
Diarrhea | T cell < 50
CMV | MAC
48
N/V/D Fish Perioral parasthesias Reversal of hot/cold sensation
Ciguatera toxin | Large reef fish
49
Fish | Flushing, urticaria, Paresthesias
Scombroid poisoning | Histamine build up
50
Fish Paresthesias, weakness Ascending paralysis, SOB
Tetrodotoxin | Puffer fish
51
Diarrhea Acute dysentery Flask-shaped ulcers
Amoebic colitis
52
Diarrhea | Turns red with NaOH
Laxative abuse
53
Malabsorption | Very high fecal fat
Pancreatitis
54
Malabsorption High fecal fat Low bile acid
Biliary disease
55
Malabsorption High fecal fat Low bile acid Abnormal breath test
Bacterial overgrowth
56
Malabsorption High fecal fat Abnormal D-xylose
Mucosal | Lymphatic
57
Diarrhea Itching Anemia
Celiac sprue
58
Diagnosing celiac sprue
Transglutaminase IgG A Ab If positive, small bowel biopsy If negative, HLA DQ2 or 8 >> gluten challenge 6-8 weeks >> repeat serology and biopsy
59
Management for dermatitis herpetiformis
Dapson
60
Diarrheal disease most associated with celiac sprue
Microscopic colitis
61
Steatorrhea Macrocytic anemia Abnormal d-xylose Flattened villi with lymphocytic and plasma cell infiltrate in the lamina propria Management
Dx: Tropical sprue Caribbean >> B12 def Asia >> folate def Tx: tetracycline + folic acid
62
Arthritis Dementia, visual disturbances Foamy macrophages PAS + Management
Dx: Whipple’s disease Tx: ceftriaxone + Bactrim or tetracycline
63
Management for bile acid malabsorption
Medium chain triglycerides
64
Management for bacterial overgrowth
Rifaximin
65
Postprandial abdominal pain Fear of eating Weight loss Decreased blood flow and atherosclerosis
Chronic mesenteric ischemia
66
Sudden onset severe abdominal pain N/V. Leukocytosis, lieus Embolism in celiac or SMA
Acute mesenteric ischemia
67
``` Hematochezia Diarrhea Abdominal pain Low flow states Thumbprinting colon ```
Ischemic colitis
68
Post-radiation | Colonoscopy with Friability of mucosa
Radiation proctolitis
69
Best management for opioid induced constipation
Senna
70
Hepatitis DNA virus
Hepatitis B
71
HBsAg + Anti-HBs - IgM
Acute hepatitis B
72
HBsAg + Anti-HBs - IgG Elevated ALT
Chronic Hepatitis B
73
HBsAg + Anti-HBs - IgG Normal ALT
Carrier Hepatitis B
74
HBsAg - Anti-HBs + IgG
Past Hep B infection
75
HBsAg - Anti-HBs + No Anti-HBc
Post Hep B vaccination
76
HBsAg - Anti-HBs - IgG
Chronic Hep B Past Hep B False +
77
Management for Post Hep B exposure and anti-HBs > 10 U/L or < 10 U/L
> 10: reassurance | < 10: HBIG + booster Hep B vaccine
78
Indications for Hep B treatment
HBV DNA > 20,000 IU/mL + ALT >2x HBV DNA > 10 IU/mL + cirrhosis Any HBV DNA + immunosuppressed If decompensated cirrhosis, transplant If HBV DNA > 20,000 IU/mL + ALT 1-2x, biopsy
79
Treatment for HepB
Tenofovir or Entecavir or Alpha-interferon
80
Treatment for HepB + HIV
Tenofovir
81
Adverse effect of interferon
Thyroid disease
82
Prevention of neonatal Hep B in Hep B mother
Treat mother with Tenofovir and give newborn Hep B vaccine and HBIG
83
Hep C Ab + HCV RNA - IGRA +
No Hep C
84
HBc IgM + Hep D
Acute coinfection | Doesn’t make hepatitis worse
85
HBc IgG + Hep D
Acute superinfection | Can cause fulminant hepatitis
86
Elevated ALP AMA + Granulomas/Lymphocytic destruction of bile ducts
Primary Biliary cholangitis
87
Smooth muscle Ab + | Piecemeal necrosis characteristic on biopsy
Autoimmune hepatitis
88
Elevated ALP Normal ALT Inflammation with concentric fibrosis around bile ducts
Primary sclerosis cholangitis
89
Screen for HCC
Liver US
90
R/o HCC
Triple phase CT
91
Management for MELD < 14 | MELD > 15
< 14: TIPS | > 15: Transplant
92
SAAG > 1.1 Total ascites protein > 2.5 < 2.5
Portal hypertension > 2.5: RHF or Hep v thrombosis < 2.5: Cirrhosis or portal v thrombosis
93
SAAG < 1.1 Total ascites protein > 2.5 < 2.5
> 2.5: Pancreatitis, TB, peritoneal carinomatosis < 2.5: Nephrotic syndrome
94
Low serum ceruloplasmin High urine copper level Copper deposition in liver
Wilson disease
95
Pregnant Elevated transaminases Coagulopathy Increased Dbili and Ammonia
Acute fatty liver of pregnancy

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