Gastroenterology Flashcards
(126 cards)
1
Q
How does achalasia present?
A
Young, nonsmoker, dysphagia to both solids and liquids, regurgitation, aspiration
2
Q
What is the best initial test for achalasia?
A
Barium swallow
3
Q
What is the most accurate test for achalasia?
A
esophageal manometry (shows absence of peristalsis)
4
Q
What is the best initial therapy for achalasia?
A
Pneumatic dilation or surgical myotomy
5
Q
What is the alternative treatment for achalasia?
A
Botox, when patient refuses other treatments
6
Q
How does esophageal cancer present?
A
Dysphagia for solids first then liquids, may have heme-positive stool or anemia Smokers and drinkers
7
Q
What is the best initial test for esophageal cancer?
A
endoscopy
8
Q
What is the best initial procedure for esophageal cancer?
A
surgical resection
9
Q
What other adjuncts are needed after surgical resection of esophageal cancer?
A
5-fluorouracil
10
Q
What is Plummer-Vinson syndrome? And what is the treatment?
A
Proximal esophageal stricture found with iron deficiency anemia; Replacement of iron is the treatment
11
Q
What is Schatzki’s ring and what is the treatment?
A
distal ring stricture with intermittent symptoms of dysphagia; best initial therapy is pneumatic dilation
12
Q
What is a peptic stricture and what is the treatment?
A
stricture resulting from acid reflux; treated with pneumatic dilation
13
Q
How does Zenker diverticulum present?
A
dysphagia with really stinky breath because rotting food in the back of esophagus because of dilation of the posterior pharyngeal constrictor muscles
14
Q
What is the best initial test for Zenker diverticulum?
A
barium study
15
Q
What is the best initial therapy for Zenker’s diverticulum?
A
surgical resection
16
Q
How does esophageal spasm(nutcracker esophagus) present?
A
severe chest pain usually after drinking cold beverage
17
Q
What is the most accurate test for esophageal spasm?
A
manometry
18
Q
What is the treatment for esophageal spasm?
A
CCB
19
Q
What is the first test for esophagitis on a HIV negative patient?
A
Endoscopy
20
Q
What do you do when an HIV patient with esophagitis that has CD4 cell count <100?
A
Give fluconazole Candida esophagitis causes >90% esophagitis in HIV patients
21
Q
What is Mallory Weiss tear?
A
tear in esophagus caused by retching/vomiting, causes sudden upper GI bleed
22
Q
What is the diagnostic test for Mallory Weiss tear?
A
Endoscopy
23
Q
What is the treatment for Mallory Weiss tear?
A
most cases resolve spontaneously, epinephrine is used if bleeding persists
24
Q
What is the diagnostic test for GERD?
A
PPI, both diagnostic and therapeutic
25
If PPI does not control GERD, what is the next step in management?
Surgical/endoscopic procedure to narrow distal esophagus
26
What is Barrett esophagus?
precancerous lesion from chronic reflux
27
What is the diagnostic test for Barrett esophagus?
Endoscopy and biopsy
28
How is Barrett esophagus treated?
PPI and repeat endoscopy every 2-3 years
29
How do you diagnose non-ulcer dyspepsia?
After endoscopy has excluded gastric cancer, ulcer disease, gastritis
30
What is peptic ulcer disease?
Can be either duodenal ulcer or gastric ulcer with the most common cause being H. pylori
31
What infection is gastritis associated with?
H. pylori infection
32
What is the most accurate test for gastritis?
endoscopy with biopsy
33
What is the treatment for gastritis?
Clarithromycin, Amoxicillin, PPI - only if H. pylori is associated with the disease
34
If patient has epigastric pain, H. pylori positive, and no ulcers, what is the treatment?
PPI alone, no abx needed because there is no ulcer disease
35
How is Zollinger-Elllison syndrome diagnosed?
Elevated gastrin level and elevated gastric acid output
36
What is the most accurate test for Zollinger Ellison syndrome?
Endoscopic Ultrasound Nuclear somatostatin scan Secretin supression (MOST ACCURATE)
37
What is the treatment of Zollinger-Ellison syndrome?
surgical resection
38
What are the diagnostic tests for UC and Crohns?
endoscopy
39
What are the blood blood tests that are positive for Crohns disease?
ASCA- Positive ANCA- Negative
40
What are the blood blood tests that are positive for Ulcerative colitis?
ASCA- Negative ANCA- Positive
41
What is the best initial treatment for both UC and Crohns?
Mesalamine
42
What are the other treatments for UC/Crohns?
- Steroids: Budesonide - Azathioprine and 6-mercaptopurine(patients with severe disease used when steroids are no longer in use) - Infliximab- used to control fistula formation in CD patients (must screen for tuberculosis because infliximab can release dormant granulomas) - Metronidazole & Ciprofloxacin- used when there is perianal involvement Surgery- curative in UC by removing colon
43
What is the most common cause of food poisoning?
campylobacter
44
What is the best initial test for infectious diarrhea?
fecal leukocytes(tells you that an invasive pathogen is present)
45
What is the most accurate for infectious diarrhea?
stool culture
46
What is the treatment with severe infectious diarrhea?
fluoroquinolones are best initial therapy
47
What antibiotic is most commonly associated with C diff?
clindamycin -but can be caused by any antibiotic
48
What is the best initial test for C diff?
Stool toxin assay
49
What is the best initial therapy for C diff?
Metronidazole switch to oral Vanc if there is no response to metronidazole(don't use IV vanc)
50
How does carcinoid syndrome present?
Flushing and episodes of hypotension
51
What is the diagnostic test for carcinoid syndrome?
urinary 5-HIAA level
52
How do you treat carcinoid syndrome?
octreotide
53
What are the causes of fat malabsorption?
Celiac disease, tropical sprue, chronic pancreatitis, Whipple disease
54
What are all forms of of malabsorption are associated with?
hypocalcemia (Vitamin D deficiency) oxalate kidney stones easy bruising and elevated INR Vitamin B12 malabsorption
55
What is the best initial test for malabsorption?
Sudan black stain of stool for presence of fat
56
What is the most sensitive test for malabsorption?
72-hour fecal fat
57
What is the best initial test for celiac disease?
Anti-gliadin, antiendomysial, and antitissue transglutaminase antibodies
58
What is the most accurate test for celiac disease?
Small bowel biopsy - must biopsy in order to rule out bowel lymphoma
59
What is the treatment for celiac disease?
elimination of wheat, oats, barley from diet
60
What is the treatment for tropical sprue?
doxycyline or TMP/SMX for 3-6 months
61
How does Whipple's disease present?
malabsorption plus arthralgia, neuologic abnormalities, ocular findings
62
What is the most accurate test for Whipple's disease?
small bowel biopsy showing PAS positivity
63
What is the treatment for Whipple's disease?
Tetracycline or TMP/SMX
64
What is the best initial test for chronic pancreatitis?
abdominal xray
65
What is the most accurate test for chronic pancreatitis?
secretin stimulation test
66
What is the treatment for chronic pancreatitis?
replace pancreatic enzymes by mouth
67
What are the symptoms of IBS?
pain relieved by BM, pain that is less at night, pain with diarrhea alternating with constipation
68
What are the diagnostic tests that need to be ordered with IBS?
stool guaiac, stool WBC, culture, ova, and parasites
69
What is the best initial therapy for IBS?
fiber
70
If fiber fails as the first line for IBS, what should be tried next?
antispasmodic/anticholinergic agent
71
What is the screening for colon cancer in the general population?
Begin at age 50 Colonoscopy every 10 years(best screening method) Fecal occult blood test yearly barium enema
72
What is the screening for colon cancer for people who have one family member with colon cancer?
Colonoscopy starting at age 40 or 10 years before the age of the family member who had cancer
73
What is the screening protocol for colon cancer for people who have three family members, two generations, one premature(\<50)?
Colonoscopy every 1-2 years starting at age 25
74
What is the screening for colon cancer for patient with familial adenomatous polyposis?
sigmoidoscopies at age 12
75
What is the presentation of diverticulosis?
low fiber, high fat, LLQ pain, lower GI bleeding
76
What is the most accurate test for diverticulosis?
barium enema
77
What is the treatment for diverticulosis?
high fiber diet
78
What is the presentation of diverticulitis?
LLQ pain, tenderness, fever, elevated WBCs
79
What is the best diagnostic test for diverticulitis?
abdominal and pelvic CT
80
What is the treatment for diverticulitis?
antibiotics cover gram negative(quinolone or cephalosporin), with anerobes use metronidazole. Cipro+Metronidazole
81
What is the most important thing to do in acute GI bleeding?
determine if there is hemodynamic instability do orthostatics (\>20 mmHg drop in systolic or rise in pulse \>10 bmp)
82
When to transfuse a patient packed RBCs?
Hct \< 30 in older person Hct \<20-25 in young person
83
When do you transfuse FFP?
When PT/INR is elevated and vitamin K is too slow
84
When do you transfuse platelets?
If patient is bleeding or about to undergo surgery and if platelets are \<50,000
85
What is the most common cause of death in GI bleeding?
MI, this is why you need to get an EKG in older patients with severe GI bleed
86
What is the most important treatment that supersedes all other interventions when it comes to GI bleeds?
Volume resuscitation
87
What is the presentation of variceal bleeding?
Alcoholic with hemetemesis and/or cirrhosis; splenomegaly, low platelets, spider angiomata
88
What is the treatment for variceal bleeding?
octreotide as an initial order Upper GI (variceal banding) If bleeding persists, TIPS (transjugular intrahepatic portosystemic shunt) to lower portal pressure
89
If endoscopy does not reveal the source of GI bleeding, what is the next best test?
technetium bleeding scan(tagged red cell scan)- gives location, but not cause
90
What test is indicated if the upper and lower endoscopy does not reveal the location of the bleed?
capsule endoscopy, can detect location of GI bleed from the small bowel
91
How does acute mesenteric ischemia present?
sudden severe abdominal pain, older patient with valvular heart disease
92
What is the initial lab findings for acute mesenteric ischemia?
metabolic acidosis and elevated amylase
93
What is the most accurate test for acute mesenteric ischemia?
angiography
94
What is the treatment for acute mesenteric ischemia?
surgical resection of bowel, surgical emergency
95
What are some causes of constipation?
dehydration, calcium channel blockers, narcotic use, hypothyroid, diabetes, ferrous sulfate, anticholinergic meds
96
What is the treatment for diabetic gastroparesis?
Erythromycin or metoclopromide
97
What is the best initial test for diagnosis of acute pancreatitis?
amylase, lipase
98
What is the most accurate test for acute pancreatitis?
abdominal CT
99
What is the treatment of acute pancreatitis?
NPO(bowel rest), hydration, pain meds
100
What is the treatment for necrotic pancreatitis?
If CT shows \>30% of necrosis, patient should receive antibiotics(imipenem), CT guided biopsy; If biopsy shows necrotic pancreas, patient should have debridement
101
How does hepatitis present?
jaundice, fatigue, weight loss, dark urine caused by bilirubin
102
Antigen and Antibody chart for Hepatitis B......
103
What is the best initial test for Hepatitis C?
Hep C antibody
104
What is the most accurate test for acute Hepatitis C?
Hep C PCR
Liver biopsy is the most accurate way of determining the seriousness of the disease
105
What is the treatment chronic hepatitis B?
antiviral therapy
Lamivudine, adefovir, entecavir, tellbivudine, tenofivir, interferon
106
What is the treatment for Chronic hepatitis C?
Interferon with Ribavarin and boceprevir
107
When is vaccination for hepatitis A and B?
during childhood
108
What are the indications for vaccination of hepatitis A and B?
Chronic liver disease, household contact with Hep A,B; men who have sex with men; chronic recipients of blood products, IV drug abusers
109
What is the treatment for a healthcare worker that has never been vaccinated that is stuck by a needle of a chronic Hep B patient?
Give hepatitis Ig and Hepatitis B vaccine
110
What are the features of cirrhosis?
edema(treat with spirinolactone), gynecomastia, palmar erythema, splenomegaly, thrombocytopenia, encephalopathy, esophageal varices(treat with propranalol)
111
When do you preform paracentesis on patient with ascites?
Any new ascites, patient with pain, fever, or tenderness
112
How is spontaneous bacterial peritonitis diagnosed?
cell count \>250 neutrophils
113
How is ascites treated?
cefotaxime
114
What is the SAAG(serum-to-ascites albumin gradient) in patients with portal hypertension?
\>1.1, if it is lees than 1.1, portal hypertension is not present
115
What is the best initial test for primary biliary cirrhosis?
elevated Alk Phos with normal bilirubin
116
What is the most accurate test for primary biliary cirrhosis?
AMA antibody
117
What is the treatment for PBC?
ursodeoxycholic acid
118
How does primary sclerosing cholangitis present?
elevated bilirubin with elevated Alk phos
119
What is the most accurate test PSC?
ERCP showing beading of biliary system, Anti-smooth antibody, ANCA positive
120
What is the treatment for PSC?
Ursodeoxycholic acid
121
What are the characteristics of WIlsons disease?
patient with cirrhosis and choreiform movements and neuropsychiatric abnormalities
122
What is the best initial test for Wilson's disease?
slit lamp looking for Kayser Fleischer rings
123
What is the most accurate test Wilson's disease?
liver biopsy
124
What is the treatment for Wilson's disease?
penicillamine, trientine
125
What is the best initial diagnostic test for hemochromatosis?
elevated serum iron and ferritin levels and low iron binding capacity
126
What is the most accurate test for hemochromatosis?
liver biposy
